Comparison of 5-Year Outcomes of Robot-Assisted Laparoscopic and Laparoscopic Partial Nephrectomy in Patients With Localized Renal Cell Carcinoma

PURPOSE: To compare the 5-year oncologic and functional outcomes of robot-assisted laparoscopic partial nephrectomy (RALPN) and laparoscopic partial nephrectomy (LPN) as treatment for localized renal cell carcinoma (RCC). MATERIALS AND METHODS: We analyzed the records of 181 patients with localized RCC who underwent RALPN (n=97) or LPN (n=84) between 2007 and 2011. Demographic and preoperative data with estimated glomerular filtration rate (eGFR), intraoperative data including warm ischemic time (WIT) and complications, oncologic outcomes (recurrence, metastasis), and rate of eGFR preservation at most recent follow-up were examined. RESULTS: WIT was shorter in the RALPN group (27±9.1 minutes) than the LPN group (31±10 minutes, p=0.019). Intraoperative complication rates were also lower in RALPN patients than LPN patients (4.1% vs. 14.3%). The eGFR preservation rate was higher in the RALPN group (84.6%) than in the LPN group (81.5%, p=0.049). Particularly, a relatively high difference in the eGFR preservation rate was observed in the RALPN group compared with the LPN group according to R.E.N.A.L. score 7–10 values (RALPN, 86.5±12.9 vs. LPN, 76.7±16.0; p=0.003). During the follow-up period, there was no local recurrence in either group and distant metastases only occurred in one patient in the RALPN group and in 2 patients in the LPN group. CONCLUSIONS: RALPN and LPN showed similar 5-year oncologic outcomes, but RALPN was superior to LPN in terms of WIT, intraoperative complications, and long-term eGFR preservation rate, especially in complex cases.

Effect of Continuous Urethro-Vesical Anastomosis Technique in Incontinence After Radical Retropubic Prostatectomy, 1:1 Matching Study / 대한배뇨장애요실금학회지

PURPOSE: Vesicourethral anastomosis (VUA) is an important step in radical prostatectomy and can affect clinical course in hospital. However, few studies comparing VUA by standard interrupted and continuous suturing techniques in radical retropubicprostatectomy (RRP) have been reported. We compared the postoperative outcomes and continence recovery rates of patients undergoing these two variations of VUA using 1:1 propensity score matching. METHODS: From January 2008 to January 2014, a total of 188 patients underwent RRP. We conducted 1:1 propensity score matching based on age, prostate volume, pathological stage, status of nerve sparing, and two baseline characteristics (preoperative prostate-specific antigen [PSA] level and Gleason score determined by pathology). Patients were assigned to two groups based on the suturing method used (interrupted or continuous). After RRP, incontinence levels were assessed at 1, 3, 6, and 12months based on pad usage per day (0, dry; or =2, incontinence). RESULTS: Each group consisted of 47 patients. The continuous group had a lower incidence of VUA site leakage (0% vs. 10.6%, P=0.022), but there were no significant differences in the rates of postoperative urethral stricture (6.4% vs. 6.4%, P=1.00) andpyuria (43.6% vs. 45.0%, P=0.770) between the two groups. The rate of recovery to social continence was greater in the continuous group at postoperative 3 months (85.1% vs. 66.0%, P=0.031). About 50% of patients had no incontinence (pad perday=0) after 6 months (59.6% in the continuous group and 51.1% in the interrupted group, P=0.407) and at postoperative 12 months, the dry rate 61.7% in the interrupted group and 80.4% in the continuous group (P=0.047). The times required toreach social continence (3.21 months vs. 3.77 months, P=0.056) and no incontinence (7.23 months vs. 7.63 months, P=0.132) were also shorter in the continuous group, but these differences were not statistically significant. CONCLUSIONS: The results of this study suggest that earlier recovery to social continence and a higher rate of complete recovery (dry) could be expected with VUA by continuous suturing. Furthermore, if adequate surgical experience is accumulated, VUAwith continuous suturing could be performed without difficulty.

The Impact of Lower Urinary Tract Symptoms on Quality of Life, Work Productivity, Depressive Symptoms, and Sexuality in Korean Men Aged 40 Years and Older: A Population-Based Survey / 대한배뇨장애요실금학회지

PURPOSE: To examine the impact of lower urinary tract symptoms (LUTS) on health-related quality of life (HRQoL) in Korean men aged > or =40 years. METHODS: A population-based, cross-sectional door-to-door survey was conducted among men aged > or =40 years. Individuals with LUTS were defined as men reporting at least one LUTS using 2002 International Continence Society definitions. Structuredquestionnaires were used to assess several dimensions of HRQoL, including generic health status (EuroQoL-five-dimensions questionnaire), work productivity (work productivity and activity impairment questionnaire), depressive symptoms (center for epidemiologic studies depression scale), and sexual health (sexual satisfaction and erectile dysfunction). The impact of LUTS was assessed by comparing several dimensions of HRQoL among men with and without LUTS. RESULTS: Of the 1,842 participants, 1,536 (83.4%) reported having at least one LUTS. The prevalence of LUTS increased with age (78.3% among those aged 40-49 years to 89.6% among those aged 60 years or older). Those with LUTS reported a significantlylower level of generic health status and worse work productivity compared with those without LUTS. Significantly more individuals with LUTS reported having a higher level of major depressive symptoms compared with those without LUTS.Those with LUTS reported worse sexual activity and enjoyment, and were significantly more likely to have erectile dysfunction than those without LUTS. CONCLUSIONS: LUTS seem to have a substantial impact on several dimensions of HRQoL in Korean men aged > or =40 years.

Multiple cores of high grade prostatic intraepithelial neoplasia and any core of atypia on first biopsy are significant predictor for cancer detection at a repeat biopsy

PURPOSE: To investigate the differences in the cancer detection rate and pathological findings on a second prostate biopsy according to benign diagnosis, high-grade prostatic intraepithelial neoplasia (HGPIN), and atypical small acinar proliferation (ASAP) on first biopsy. MATERIALS AND METHODS: We retrospectively reviewed the records of 1,323 patients who underwent a second prostate biopsy between March 1995 and November 2012. We divided the patients into three groups according to the pathologic findings on the first biopsy (benign diagnosis, HGPIN, and ASAP). We compared the cancer detection rate and Gleason scores on second biopsy and the unfavorable disease rate after radical prostatectomy among the three groups. RESULTS: A total of 214 patients (16.2%) were diagnosed with prostate cancer on a second biopsy. The rate of cancer detection was 14.6% in the benign diagnosis group, 22.1% in the HGPIN group, and 32.1% in the ASAP group, respectively (p<0.001). When patients were divided into subgroups according to the number of positive cores, the rate of cancer detection was 16.7%, 30.5%, 31.0%, and 36.4% in patients with a single core of HGPIN, more than one core of HGPIN, a single core of ASAP, and more than one core of ASAP, respectively. There were no significant differences in Gleason scores on second biopsy (p=0.324) or in the unfavorable disease rate after radical prostatectomy among the three groups (benign diagnosis vs. HGPIN, p=0.857, and benign diagnosis vs. ASAP, p=0.957, respectively). CONCLUSIONS: Patients with multiple cores of HGPIN or any core number of ASAP on a first biopsy had a significantly higher cancer detection rate on a second biopsy. Repeat biopsy should be considered and not be delayed in those patients.

The Prevalence of Lower Urinary Tract Symptoms in Korean Men Aged 40 Years or Older: A Population-Based Survey / 대한배뇨장애요실금학회지

PURPOSE: The aim of this study was to evaluate the prevalence of lower urinary tract symptoms (LUTS) among Korean men aged > or =40 years. METHODS: We performed a population-based, cross-sectional door-to-door survey on a geographically stratified random sample of men aged > or =40 years. All respondents were asked about the presence of individual LUTS using a questionnaire based on 2002 International Continence Society definitions. For comparison, we also defined nocturia as two or more nocturnal micturitions per night. The International Prostate Symptom Score (IPSS) questionnaire was used to assess LUTS severity. RESULTS: Responses from 1,842 subjects were analyzed. The overall prevalence of LUTS was 83.4%. Storage LUTS (70.1%) were more prevalent than voiding (60.4%) or postmicturition LUTS (38.3%). When nocturia was defined as two or more nocturnal micturitions per night, voiding symptoms became most prevalent (storage, 39.7%; voiding, 60.4%; and postmicturition, 38.3%). More than 90% of our population described the severity of their urinary symptoms as moderate (8-19) or severe (20-35). The prevalence and severity of LUTS increased with age. CONCLUSIONS: LUTS are highly prevalent among Korean men, and its prevalence increases with age. Increased public awareness and a larger number of treatment options are needed to appropriately manage symptoms and their consequences.

Do Rotational Shifts Affect Micturition Patterns in Real Practice? A Pilot Study in Healthy, Young Female Nurses / 대한배뇨장애요실금학회지

PURPOSE: Healthy, young individuals are known to exhibit circadian variation in urinary functions. However, the effects of chronic circadian disturbance on voiding functions are largely unknown. The present work compared the effects of rotational shifts on the micturition patterns of female nurses to that in female nurses with routine daytime shifts. METHODS: A total of 19 nurses without lower urinary tract symptoms who worked rotational shifts for an average duration of 2 years were recruited. A voiding diary was kept for 9 consecutive days, and the overactive bladder symptom score (OABSS) questionnaire was completed three times, starting 3 days before their night duties until 3 days after completion of their night duties. For comparison, seven nurses with regular shifts completed a 3-day voiding diary and the OABSS questionnaire. RESULTS: Female nurses working rotational shifts had lower overall urine production and had decreased urination frequency and nocturia than female nurses working regular shifts, even when the nurses who worked rotational shifts had a regular night's sleep for at least 7 days. Upon reinitiation of night duty, overall urine production increased significantly, with no significant changes in urgency and frequency. When these nurses returned to daytime duty, the volume of urine decreased but nocturnal urine production remained high, and the incidence of nocturia also increased significantly. However, the effects on OABSS score were not significant under the study design used. CONCLUSIONS: Long-term rotational shifts resulted in adaptive changes such as decreased urine production and frequency in healthy, young female nurses. In addition, their micturition patterns were significantly affected by abrupt changes in their work schedules. Although working in shifts did not increase urgency or frequency of urination in healthy, young female nurses working rotational shifts for an average 2 years, large-scale studies are needed to systematically analyze the influence of shift work timings on micturition in humans.

Factors Affecting the Outcome of Extracorporeal Shock Wave Lithotripsy for Unilateral Urinary Stones in Children: A 17-Year Single-Institute Experience

PURPOSE: Extracorporeal shock wave lithotripsy (ESWL) is a first-line treatment for pediatric urinary stone disease. We aimed to determine the factors affecting the outcome of ESWL for unilateral urinary stones in children. MATERIALS AND METHODS: A total of 81 pediatric patients aged 0 to 16 years with urinary stones treated by ESWL from January 1995 through May 2012 were retrospectively reviewed. All patients were required to have unilateral urinary stone disease. Children who underwent other surgical procedures before ESWL were excluded. Outcomes evaluated after ESWL were the stone-free rate at 3 months after ESWL, success within a single session, and success within three sessions. Factors affecting the success within three sessions were also analyzed. RESULTS: The final analysis was for 42 boys and 22 girls (mean age, 9.2+/-5.2 years). Of these 64 patients, 58 (90.6%) were treated by ESWL without other surgical procedures and 54 (84.4%) were successfully treated within three ESWL sessions. In the multivariate analysis, multiplicity (odds ratio [OR], 0.080; 95% confidence interval [CI], 0.012 to 0.534; p=0.009) and large stone size (>10 mm; OR, 0.112; 95% CI, 0.018 to 0.707; p=0.020) were significant factors that decreased the success rate within three ESWL sessions. CONCLUSIONS: Most of the pediatric urinary stone patients in our study (90.6%) were successfully treated by ESWL alone without additional procedures. If a child has a large urinary stone (>10 mm) or multiplicity, clinicians should consider that several ESWL sessions might be needed for successful stone fragmentation.

Relationship Between Patient Position and Pain Severity During Shock Wave Lithotripsy for Renal Stones With the MODULITH SLX-F2 Lithotripter: A Matched Case-Control Study

PURPOSE: We evaluated the association between shock wave lithotripsy (SWL)-related pain and patient positioning during SWL. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 162 patients who underwent their first SWL session for single renal stones from May 2010 to August 2011. One hundred thirteen patients underwent SWL in the supine position and 49 did so in the lateral position. To evaluate an unbiased estimation of the positional effect on pain severity during SWL, both groups (supine vs. lateral) were matched according to sex, age, body mass index, stone location, and stone size. Thirty-four patients from each group were selected for analysis. Pain was evaluated with an average visual analogue scale (VAS-avg) and maximum visual analogue scale (VAS-max). Analgesic usage was also compared between the groups. RESULTS: All patients (n=34) in the supine group had radio-opaque stones compared with only 47.1% of the patients in the lateral group (n=16). The VAS-avg and VAS-max of the lateral group were significantly lower than those of the supine group (1.2+/-1.0 and 3.1+/-1.7 for VAS-avg and 2.5+/-1.8 and 4.7+/-1.9 for VAS-max, respectively, p<0.05). However, analgesic usage between groups did not differ significantly (17.6% in the supine group vs. 5.9% in the lateral group, p=0.259). In a subgroup analysis confined to patients with radio-opaque stones, the supine group still suffered more pain. CONCLUSIONS: Patients with renal stones suffered more SWL-related pain in the supine position than in the lateral position. During SWL, positioning of patients should be considered a predictive factor for SWL-related pain.

Can 80 W KTP Laser Vaporization Effectively Relieve the Obstruction in Benign Prostatic Hyperplasia?: A Nonrandomized Trial

PURPOSE: There is little data evaluating the changes of severity of bladder outlet obstruction after 80 W-potassium-titanyl-phosphate (KTP) photoselective laser vaporization prostatectomy (PVP) by pressure-flow study. We evaluated the efficacy of PVP to relieve the obstruction in benign prostate hyperplasia (BPH) compared with transurethral resection of the prostate (TURP). MATERIALS AND METHODS: This is a prospective, non-randomized single center study. The inclusion criteria were as follows: Men suffering from lower urinary tract symptoms (LUTS) secondary to BPH, age > or =50 years, International Prostatic Symptom Score (IPSS) > or =13, maximum flow rate (Qmax) or =40 was decreased from 64% to 4% in the PVP group and from 86% to 14% in the TURP group. CONCLUSIONS: PVP could reduce the prostate volume effectively and relieve bladder outlet obstruction similar to TURP by the 6-month follow up in men with BPH.

Medical Profession's Awareness and Attitude Toward the Sexuality of Cancer Patients in South Korea / 대한남성과학회지

PURPOSE: To investigate the practice and attitude of healthcare professionals toward the sexuality of cancer patients. MATERIALS AND METHODS: The subjects were comprised of doctors and nurses who served at two medical centers. Questionnaires consisted of five domains and fourteen questions were disseminated via emails in March 2009. The first domain (3 questions) pertained the recognition of sexual dysfunction in cancer patients, the second (2 questions) pertained cancer patients' experience of sexual dysfunction, the third (3 questions) pertained the attitude to cancer patients with sexual dysfunction, the fourth (3 questions) pertained capacity for sexual dysfunction treatment, and the fifth (3 questions) pertained problems or difficulties encountered when facing cancer patients' sexual dysfunction. RESULTS: Three hundred and twenty-six men and women completed the questionnaires, giving a response rate of 85.4%. The mean age was 33.6 years. The proportion of doctors and nurses were respectively 48.2% and 51.8%. The proportion of males and females were 29.8%, and 70.2%, respectively. Ninety point five per cent (90.5%) of respondents answered that cancer patients' sexual dysfunction is important to quality of life. However, fewer medical professionals (27.4%) give an affirmative answer that patients requested sexual dysfunction therapy. The occurred particularly less frequently in physicians (13.2%) than in surgeons (55.6%). Fifty-four point six (54.6%) percent of respondents said that they tried to resolve the problem when patients asking for treatment of sexual dysfunction. Only 38.3% of respondents experienced little or no difficulty in behaving naturally when counseling cancer patients about their sexual dysfunction. Female doctors and nurses more often experience embarrassment when addressing sexuality with patients. In addition, most respondents (84.0%) felt that theoretical knowledge on cancer patients' problems is needed. CONCLUSIONS: Most healthcare professionals agreed that sexual problems of cancer patients were important for quality of life. However, they frequently felt a lack of communicating skills and theoretical knowledge. Education programs on this issue and an appropriate contact system with specialists should be established.

Laparoendoscopic Single-Site Pyeloplasty Using Additional 2 mm Instruments: A Comparison with Conventional Laparoscopic Pyeloplasty

PURPOSE: Despite a recent surge in the performance of laparoendoscopic single-site surgery (LESS), concerns remain about performing LESS pyeloplasty (LESS-P) because of the technical difficulty in suturing. We report our techniques and initial experiences with LESS-P using additional needlescopic instruments and compare the results with conventional laparoscopic pyeloplasty (CL-P). MATERIALS AND METHODS: Nine patients undergoing LESS-P were matched 2:1 with regard to age and side of surgery to a previous cohort of 18 patients who underwent CL-P. In both groups, the operating procedures were performed equally except for the number of access points. In the LESS-P group, we made a single 2 cm incision at the umbilicus and used a homemade port. We also used additional 2 mm needlescopic instruments at the subcostal area to facilitate suturing and the ureteral stenting. RESULTS: The preoperative characteristics were comparable in both groups. Postoperatively, no significant differences were noted between the LESS-P and CL-P cases in regard to length of stay, estimated blood loss, analgesics required, and complications. But, LESS-P was associated with a shorter operative time (252.2 vs. 309.7 minutes, p=0.044) and less pain on postoperative day one (numeric rating scale 3.7 vs. 5.6, p=0.024). The success rate was 94% with CL-P (median, 23 months) and 100% with LESS-P (median, 14 months). CONCLUSIONS: Our initial experiences suggest that LESS-P is a feasible and safe procedure. The use of additional 2 mm instruments can help to overcome the difficulties associated with LESS surgery.

Transumbilical Laparoendoscopic Single-Site Ureterolithotomy for Large Impacted Ureteral Stones: Initial Experiences

PURPOSE: We presented our initial clinical experiences with transumbilical laparoendoscopic single-site (LESS) ureterolithotomy for large, impacted ureteral stones. MATERIALS AND METHODS: Between March 2009 and November 2009, seven LESS ureterolithotomies were performed at our institute. During the operation, we made a single 2 cm incision at the umbilicus and a homemade port by using a small wound retractor (Alexis(R), Applied Medical, Rancho Santa Margarita, USA), a surgical glove, and conventional trocars. The operation was performed in the same manner as conventional laparoscopic surgery. The mean maximal stone diameter was 21.9 mm (range, 16.0-27.0 mm). There were six cases of upper ureteral stones and one case of a mid-ureteral stone. Perioperative and postoperative parameters were evaluated. RESULTS: The mean operative time was 197.1 min (range, 150-270 min). No transfusions were required. The mean postoperative hospital stay was 3.3 days (range, 2-6 days). The mean pain intensity on a visual analogue scale (VAS) on postoperative day 2 was 26 mm (range, 0-80 mm), and the mean cosmetic VAS at 6 weeks after the operation was 0 mm. The mean time for patients to return to their baseline activities was 4.0 days (range, 3-7 days). In six cases, all stones were completely removed on the basis of postoperative radiologic evaluation. There were no cases of major complications, including internal organ injury, urinary leakage, or urinary tract infection. CONCLUSIONS: Transumbilical LESS ureterolithotomy can be considered as an alternative treatment option with minimal invasiveness and good effectiveness for large, impacted ureteral stones.

The Role of Endorectal Magnetic Resonance Imaging in Predicting Extraprostatic Extension and Seminal Vesicle Invasion in Clinically Localized Prostate Cancer

PURPOSE: We aimed to assess the clinical value of endorectal magnetic resonance imaging (MRI) in predicting extraprostatic extension and seminal vesicle invasion in patients with clinically localized prostate cancer. MATERIALS AND METHODS: A total of 54 patients who underwent radical prostatectomy for clinically localized prostate cancer were retrospectively analyzed. The findings of endorectal MRI, performed at least 3 weeks after biopsy, were compared with the pathological results of radical prostatectomy specimens. The sensitivity, specificity, and accuracy of the detection of extraprostatic extension and seminal vesicle invasion were calculated. RESULTS: The sensitivity, specificity, and accuracy of the endorectal MRI findings were 50.0%, 82.6%, and 77.8% for the detection of extraprostatic extension, respectively, and 75.0%, 92.0%, and 90.7% for the detection of seminal vesicle invasion, respectively. The sensitivity of endorectal MRI in the detection of extraprostatic extension improved as the Gleason score increased. CONCLUSIONS: Endorectal MRI findings demonstrated modest sensitivity for predicting extraprostatic extension, whereas specificity was relatively high. In addition, endorectal MRI showed better sensitivity for detecting high-grade tumors.

Efficacy and Safety of "Tension-free" Placement of Gynemesh PS for the Treatment of Anterior Vaginal Wall Prolapse / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the efficacy and safety of the tension-free placement of a monofilament polypropylene mesh for the repair of an anterior vaginal wall prolapse (AVWP). MATERIALS AND METHODS: Women aged > or = 30 years with an AVWP stage of II or greater were included. Forty-nine women underwent trans-vaginal repair using a Gynemesh(TM) PS. Forty-six women who had symptomatic stress urinary incontinence received a midurethral sling (MUS). At the 12-month follow-up, evaluations were made for changes in the Pelvic Organ Prolapse Quantification (POP-Q) stage and Pelvic Floor Distress Inventory. Cure was defined as a POP-Q stage of 0 and improvement as a stage of I. Complications were also evaluated. RESULTS: The cure rate was 71.4%, and the improvement rate was 18.4%. Obstructive/discomfort, irritative, and stress subscale scores of the Urinary Distress Inventory anterior and posterior subscale scores of the POP Distress Inventory and the obstructive subscale score of the Colo-Rectal-Anal Distress Inventory were significantly improved. Thirty-two of the 46 women (69.6%) who received MUS procedures reported no leakage after surgery. Complications were 2 cases of increased intraoperative bleeding and 1 case of vaginal erosion. CONCLUSIONS: Trans-vaginal repair using a Gynemesh(TM) PS is a feasible and effective procedure for the treatment of AVWP with no significant complications.

Anatomical and Functional Outcomes of Posterior Intravaginal Slingplasty for the Treatment of Vaginal Vault or Uterine Prolapse: A Prospective, Multicenter Study

PURPOSE: We aimed to evaluate the anatomical and functional outcomes of posterior intravaginal slingplasty (P-IVS) for the treatment of a vaginal vault or uterine prolapse (VP/UP). MATERIALS AND METHODS: This was a 12-month prospective, multicenter, observational study. Women aged over 30 years who presented with stage II or greater VP/UP underwent P-IVS by four urologists at four university hospitals. Preoperatively, pelvic examination by use of the Pelvic Organ Prolapse Quantification (POP-Q) system, the Pelvic Floor Distress Inventory (PFDI) questionnaire, the 3-day frequency volume chart, and uroflowmetry were completed. At the 12-month follow-up, changes in the POP-Q, PFDI, frequency volume chart, and uroflowmetry parameters were assessed. Cure was defined as VP/UP stage 0 and improvement as stage I. RESULTS: The cure and improvement rates among the 32 women were 65.6% and 34.4%, respectively. All subscale scores of the Urinary Distress Inventory, the general subscale score of the Pelvic Organ Prolapse Distress Inventory, and the rectal prolapse subscale score of the Colo-Rectal-Anal Distress Inventory were significantly improved. There were no significant changes in the frequency volume chart or uroflowmetry parameters. There was one case of surgery-related transfusion. CONCLUSIONS: Trans-vaginal repair by P-IVS is an effective and safe procedure for restoring the anatomical defect and improving the associated pelvic floor symptoms in women with VP/UP.

Development and Validation of the Korean Version of Expanded Prostate Cancer Index Composite: Questionnaire Assessing Health-Related Quality of Life after Prostate Cancer Treatment

PURPOSE: Although the quality of life (QoL) of prostate cancer (PCa) patients is a major issue, there is no unified and useful methodology for assessing QoL. The Expanded Prostate Cancer Index Composite (EPIC) is a globally used tool to measure QoL after PCa treatment that comprises urinary, bowel, sexual, and hormonal domains. Acknowledging the need for such a tool applicable to Korean PCa patients, we translated EPIC into Korean and validated the new version. MATERIALS AND METHODS: The Korean version of EPIC was devised by translation, back-translation, and reconciliation. Subsequently, we randomly selected 153 patients with localized PCa treated with radical perineal prostatectomy (67, 43.8%), radical retropubic prostatectomy (19, 12.4%), laparoscopic radical prostatectomy (12, 7.8%), robot-assisted laparoscopic radical prostatectomy (36, 23.5%), and high-intensity focused ultrasound ablation of the prostate (19, 12.4%) and asked them to complete EPIC. Reliability was assessed by test-retest correlation and Cronbach's alpha. Validity was assessed by factor analysis, interscale correlation, and correlation with Functional Assessment of Cancer Therapy-Prostate (FACT-P). RESULTS: Test-retest correlation and Cronbach's alpha were high in each of the domains (0.92, 0.91, 0.76, 0.84 and 0.86, 0.84, 0.92, 0.83, p<0.0001). Interscale correlation among the domains was low (r<0.37), which indicated that EPIC is composed of proper domains. Interscale correlation between the function and bother subscales was high (0.94, 0.81, 0.84 and 0.80, p<0.0001). EPIC domains had low correlation with FACT-P, permitting complementary use. CONCLUSIONS: The Korean version of EPIC was developed by a proper process, as evident by its high reliability and validity. Therefore, it is a reliable, comprehensive, systematic method that evaluates QoL in Korean patients after PCa treatment. Furthermore, it can be adapted as an objective methodology for research globally.

Desmopressin is an Effective Treatment for Mixed Nocturia with Nocturnal Polyuria and Decreased Nocturnal Bladder Capacity

To investigate the efficacy and safety of desmopressin in patients with mixed nocturia, Patients aged > or =18 yr with mixed nocturia (> or =2 voids/night and a nocturnal polyuria index [NPi] >33% and a nocturnal bladder capacity index [NBCi] >1) were recruited. The optimum dose of oral desmopressin was determined during a 3-week dose-titration period and the determined dose was maintained for 4 weeks. The efficacy was assessed by the frequency-volume charts and the sleep questionnaire. The primary endpoint was the proportion of patients with a 50% or greater reduction in the number of nocturnal voids (NV) compared with baseline. Among 103 patients enrolled, 94 (79 men and 15 women) were included in the analysis. The proportion of patients with a 50% or greater reduction in NV was 68 (72%). The mean number of NV decreased significantly (3.20 to 1.34) and the mean nocturnal urine volume, nocturia index, NPi, and NBCi decreased significantly. The mean duration of sleep until the first NV was prolonged from 118.4+/-44.1 to 220.3+/-90.7 min (P<0.001). The overall impression of patients about their quality of sleep improved. Adverse events occurred in 6 patients, including one asymptomatic hyponatremia. Desmopressin is an effective and well-tolerated treatment for mixed nocturia.

Efficacy and Safety of Tamsulosin for the Treatment of Non-neurogenic Voiding Dysfunction in Females: A 8-Week Prospective Study

We evaluated the therapeutic effects of tamsulosin for women with non-neurogenic voiding dysfunction. Women who had voiding dysfunctions for at least 3 months were included. Inclusion criteria were age > or =18 yr, International Prostate Symptom Score (IPSS) of > or =15, and maximum flow rate (Q(max)) of > or =12 mL/sec and/or postvoid residuals (PVR) of > or =150 mL. Patients with neurogenic voiding dysfunction or anatomical bladder outlet obstruction were excluded. All patients were classified according to the Blaivas-Groutz nomogram as having no or mild obstruction (group A) or moderate or severe obstruction (group B). After 8 weeks of treatment, treatment outcomes and adverse effects were evaluated. One hundred and six patients were evaluable (70 in group A, 36 in group B). After treatments, mean IPSS, bother scores, Q(max), PVR, diurnal and nocturnal micturition frequencies and scored form of the Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTS-SF) were changed significantly. Eighty-nine patients (84%) reported that the treatment was beneficial. The proportion of patients reported that their bladder symptoms caused "moderate to many severe problems" were significantly decreased. No significant difference were observed between the groups in terms of IPSS, bother score, Q(max), PVR, micturition frequency, and BFLUTS-SF changes. Adverse effects related to medication were dizziness (n=3), de novo stress urinary incontinence (SUI) (n=3), aggravation of underlying SUI (n=1), fatigue (n=1). Tamsulosin was found to be effective in female patients with voiding dysfunction regardless of obstruction grade.

Treatment Outcomes of Retrograde Intrarenal Surgery for Renal Stones and Predictive Factors of Stone-Free

PURPOSE: The aim of this study was to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) for the treatment of renal stones and to analyze the predictive factors for stone-free. MATERIALS AND METHODS: We retrospectively reviewed the records of patients who underwent RIRS for renal stones from January 2000 to July 2009. We identified 66 RIRSs (63 patients with 3 bilateral renal stones) and collected data. Stone-free and success were respectively defined as no visible stones and clinically insignificant residual stones less than 3 mm on postoperative imaging; predictive factors for stone-free were evaluated. RESULTS: Of the 66 renal stones, 18 stones (27.3%) were located in the upper pole or midpole or renal pelvis and 48 (72.7%) in the lower pole with or without others, respectively. The mean cumulative stone burden was 168.9+/-392.5 mm2. The immediate postoperative stone-free rate was 69.7%, and it increased to 72.7% at 1 month after surgery. The success rate was 80.3% both immediately after the operation and 1 month later. In the multivariate analysis, stone location except at the lower pole (p=0.049) and small cumulative stone burden (p=0.002) were significantly favorable predictive factors for the immediate postoperative stone-free rate. The overall complication rate was 6%. CONCLUSIONS: RIRS is a safe and effective treatment for renal stones. The stone-free rate of RIRS was particularly high for renal stones with a small burden, except for those located in the lower pole. RIRS could be considered in selective patients with renal stones.

Difference in Results of Ultrasonography and Diuretic Renograms after Pyeloplasty in Children with Unilateral Ureteropelvic Junction Obstruction

PURPOSE: Controversies persist on pyeloplasty follow-up, and the aim of this study was to assess the differences and interpretations in results of postoperative ultrasonography and diuretic renograms. MATERIALS AND METHODS: The study population consisted of 46 patients who underwent pyeloplasty between 1997 and 2003. The average patient age was 7.0 months (range, 2-36 months). Serial changes in hydronephrosis were evaluated by consecutive ultrasonography at 1, 4, 10, and 24 months after pyeloplasty, and a diuretic 99mTc-MAG3 renal scan was performed 4 months after the surgery. RESULTS: Ultrasonography showed that 11 (24%), 27 (59%), 35 (76%), and 39 (89%) patients had improved in hydronephrosis at 1, 4, 10, and 24 months after pyeloplasty, respectively. Diuretic renal scans showed that of 27 patients who showed improvements in hydronephrosis at 4 months after pyeloplasty, only 17 (63%) had improved excretion and 22 (81%) had preservation of different renal function (DRF). Among 19 patients with persistent or worsened hydronephrosis, 10 (53%) had improved excretion and 13 (68%) had preserved DRF. CONCLUSIONS: The results of ultrasonography and diuretic renal scan studies can differ in the same case after pyeloplasty. We recommend that improvements in hydronephrosis be assessed individually by ultrasonography, renal scans, and clinical status to determine surgical outcomes.