Hypofractionated intensity-modulated radiotherapy in patients with localized prostate cancer: a preliminary study

PURPOSE: The aim of this work was to assess the efficacy and tolerability of hypofractionated intensity-modulated radiotherapy (IMRT) in patients with localized prostate cancer. MATERIALS AND METHODS: Thirty-nine patients who received radical hypofractionated IMRT were retrospectively reviewed. Based on a pelvic lymph node involvement risk of 15% as the cutoff value, we decided whether to deliver treatment prostate and seminal vesicle only radiotherapy (PORT) or whole pelvis radiotherapy (WPRT). Sixteen patients (41%) received PORT with prostate receiving 45 Gy in 4.5 Gy per fraction in 2 weeks and the other 23 patients (59%) received WPRT with the prostate receiving 72 Gy in 2.4 Gy per fraction in 6 weeks. The median equivalent dose in 2 Gy fractions to the prostate was 79.9 Gy based on the assumption that the α/β ratio is 1.5 Gy. RESULTS: The median follow-up time was 38 months (range, 4 to 101 months). The 3-year biochemical failure-free survival rate was 88.2%. The 3-year clinical failure-free and overall survival rates were 94.5% and 96.3%, respectively. The rates of grade 2 acute genitourinary (GU) and gastrointestinal (GI) toxicities were 20.5% and 12.8%, respectively. None of the patients experienced grade ≥3 acute GU and GI toxicities. The grade 2-3 late GU and GI toxicities were found in 8.1% and 5.4% of patients, respectively. No fatal late toxicity was observed. CONCLUSION: Favorable biochemical control with low rates of toxicity was observed after hypofractionated IMRT, suggesting that our radiotherapy schedule can be an effective treatment option in the treatment of localized prostate cancer.

The Changes of Psychometric Profiles after Medical Treatment of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

OBJECTIVE: To investigate the relationship of somatization and depression with the degree of lower urinary tract symptoms suggestive of benign prostate hyperplasia (LUTS/BPH) and changes in psychometric profiles including somatization and depression after treatment of LUTS/BPH. METHODS: Subjects were evaluated at baseline and at week 12 following routine treatment for LUTS/BPH using the International Prostate Symptom Score (IPSS) to measure the severity of LUTS/BPH, the Overactive Bladder Symptom Score (OABSS) to measure the severity of OAB, the Patient Health Questionnaire-9 (PHQ-9) to assess depression, and the Patient Health Questionnaire-15 (PHQ-15) to evaluate somatization. The correlation of somatization and depression with the degree of LUTS/BPH symptoms at baseline and changes in somatization and depression after LUTS/BPH treatment were assessed using relevant statistical analyses. RESULTS: One hundred and twenty patients agreed to participate in this study, and 101 (84.2%) completed the 12-week trial and responded to the study questionnaires. At baseline, total IPSS score was correlated with PHQ-9 (r=0.475, p=0.005) and PHQ-15 (r=0.596, p<0.001) scores. The results after the 12-week treatment clearly show significant improvement in both PHQ-9 (p <0.001) and PHQ-15 (p=0.019) scores, and the PHQ-9 (r=0.509, p=0.048) and PHQ-15 (r=0.541, p=0.016) scores were positively correlated with total IPSS. CONCLUSION: Our preliminary results indicated that severity of LUTS is correlated with severity of somatization and depression. Further, the improvement of LUTS after treatment may have positive impacts on somatization and depression.

Erratum: Efficacy and Tolerability of Anticholinergics in Korean Children with Overactive Bladder: A Multicenter Retrospective Study

We made a mistake in our recently published article.

Efficacy and Tolerability of Anticholinergics in Korean Children with Overactive Bladder: A Multicenter Retrospective Study

We investigated the efficacy and tolerability of various anticholinergics in Korean children with non-neurogenic overactive bladder (OAB). A total of 326 children (males:females= 157:169) aged under 18 yr (mean age 7.3+/-2.6 yr) who were diagnosed with OAB from 2008 to 2011 were retrospectively reviewed. The mean duration of OAB symptoms before anticholinergic treatment was 16.9+/-19.0 months. The mean duration of medication was 5.6+/-7.3 months. Urgency urinary incontinence episodes per week decreased from 1.9+/-3.1 to 0.4+/-1.5 times (P<0.001). The median voiding frequency during daytime was decreased from 9.2+/-5.4 to 6.3+/-4.2 times (P<0.001). According to 3-day voiding diaries, the maximum and average bladder capacity were increased from 145.5+/-66.9 to 196.8+/-80.3 mL and from 80.8+/-39.6 to 121.8+/-56.5 mL, respectively (P<0.001). On uroflowmetry, maximum flow rate was increased from 17.6+/-8.4 to 20.5+/-8.2 mL/sec (P<0.001). Adverse effects were reported in 14 (4.3%) children and six children (1.8%) discontinued medication due to adverse effects. Our results indicate that anticholinergics are effective to improve OAB symptoms and tolerability was acceptable without severe complications in children.

A Nationwide Epidemiological Study of Nocturnal Enuresis in Korean Adolescents and Adults: Population Based Cross Sectional Study

We performed a nationwide epidemiological study to evaluate the prevalence and characteristics of nocturnal enuresis (NE) in Korean adolescents and adults. A questionnaire was sent via e-mail to 51,073 people aged 16-40 yr by stratified sampling according to age, sex, and region among a 200,000 internet survey panel pool. The questionnaire included following information; presence or absence of NE, frequency of NE, possible risk factors for NE, self-esteem scale score and depression score results, and measures for the treatment of NE. Among the 2,117 responders, 54 (2.6%) had NE (> or =1 enuretic episode within 6 months). Of 54 bedwetters, 9.3% wet > or =1 night per week and 20.5% wet > or =1 per month. The prevalence rates remained relatively stable with no apparent trend of reduction with age. The presence of sleep disturbance, family history, urgency, or urge incontinence increased the probability of NE episode significantly. The self-esteem score was lower (P=0.053) and the depression scale score was higher (P=0.003) in bedwetters compared with non-bedwetters. Overall 2.6% of Korean aged 16-40 yr have NE. The higher rate of urgency and urge incontinence in adolescent and adult enuretics suggests that bladder function has an important role in adolescent and adult NE.

Functional, Morphologic, and Molecular Biological Changes in the Bladder of OLETF Diabetic Rats according to Duration of Diabetes Mellitus

PURPOSE: Our study was undertaken to investigate changes in the bladder according to duration of diabetes mellitus in the Otsuka Long Evans Tokushima Fatty (OLETF) rat model, which is similar to type 2 diabetes. MATERIALS AND METHODS: OLETF rats (n=14) and Long Evans Tokushima Otsuka (LETO, n=14) rats were used. LETO is a normal control of OLETF. The animals were assigned to 4 groups: L-40 group, LETO rats 40 weeks after birth (n=7); O-40 group, OLETF rats 40 weeks after birth (n=7); L-60 group, LETO rats 60 weeks after birth (n=7); and O-60 group, OLETF rats 60 weeks after birth (n=7). At 40 weeks or 60 weeks after birth, blood glucose, cystometry, bladder weight, detrusor contractility, and mRNA expression of nerve growth factor (NGF) were assessed. RESULTS: Cystometry showed that diabetic bladders had increased compliance compared with the control groups at 40 and 60 weeks, and the O-60 group had greater compliance than the O-40 group. Contractile responses to electrical stimulation, bethanecol (250microM), and ATP (10 mM) were decreased in the experimental groups compared with the control groups at 40 and 60 weeks, and the O-60 group had a lower contractile response than the O-40 group. The mRNA expression of NGF was decreased in the experimental groups compared with the control groups, and the O-60 group had lower expression than the O-40 group. Changes in NGF were identified through immunohistochemical staining. CONCLUSIONS: The degree of diabetic cystopathy in OLETF rats was changed by duration of type 2 diabetes mellitus. Our results showed that the changes in the bladder in type 2 diabetes mellitus can be identified through a new rat model.

The factors of pain and anxiety associated with urodynamics in female patients

PURPOSE: Urodynamic study (UDS) is widely used to evaluate voiding dysfunction, however, it is invasive and bothersome for patients because it requires catheterization into the urethra and anus. We assessed patients' anxiety and pain levels caused by UDS. MATERIALS AND METHODS: A total of 60 female patients who were undergoing UDS were included in the study on a prospective basis. Anxiety level was taken prior to the procedure and pain level was taken immediately after the procedure by visual analogue scale (VAS). Just after the procedures, they were asked if they were willing to undergo the same procedure and if they could recommend the procedure to another people if medically indicated. 60 patients were divided into 2 groups: urodynamic urethral catheters (9Fr, PVC, n=30) were used in group I and Foley catheters (10Fr, Silicon, n=30) were used in group II. RESULTS: The mean age of both groups were 45.5+/-5.3 (group I)and 45.5+/-3.8 (group II)years old. The anxiety and pain levels were relatively high, but there was no significant difference between both groups in pain level. Anxiety level prior to UDS was correlated with pain level (r=0.492, p<0.001). 42 out of 60 patients (70.0%) answered they were willing to undergo UDS if they were asked again and 37 patients (61.7%) answered they could recommend the procedure to another people. 21 patients (35.0%) were menopausal women and they showed higher anxiety level compared to non-menopausal women. CONCLUSION: Female patients felt anxiety before UDS and pain immediately after UDS, especially in menopausal women, and the more anxious they were, the more painful they felt. Therefore, we need to provide sufficient explanation with regard to the procedure for patients prior to UDS to diminish patients' anxiety and pain.

The Prevalence and Risk Factors of Overactive Bladder in Korean Children: A Comparative Analysis according to Definition / 대한비뇨기과학회지

PURPOSE: We wanted to estimate the prevalence and risk factors of overactive bladder(OAB) in Korean children who were 5-13 years of age, according to the definition of OAB. MATERIALS AND METHODS: A randomly selected cross-sectional study was conducted on 26 kindergartens and 27 elementary schools nationwide in Korea. There were 19,240 children; a parent was asked to complete the questionnaires, which included items about OAB and the children's voiding and defecating habits. OAB was defined as urgency with or without urge incontinence, and usually with an increased daytime frequency and nocturia(ICCS 2006, group A) or an increased daytime frequency(>8 times/day) and/or urge urinary incontinence with or without urgency (group B); its prevalence and associated factors were investigated. RESULTS: The response rate for the questionnaires was 85.84%. The overall prevalence of OAB was 16.59%(group A) and 18.79%(group B). For groups A and B, the prevalence of OAB decreased with age from 22.89% to 12.16% and from 40.44% to 9.60%, respectively(p=0.0001). The overall rate of wet and dry OAB was 26.97% and 73.03%, respectively. Compared to the normal group, the children with OAB had a higher prevalence of nocturnal enuresis(NE), constipation, fecal incontinence, a history of urinary tract infection and delayed bladder control in both groups A and B(p<0.05). The rate of increased daytime frequency and urge incontinence were 3.69% and 2.31%(p=0.009), and 26.97% and 14.78%(p=0.0001) in group A and for the non-OAB children, respectively; their prevalence in group A decreased with age from 5.04% to 3.06% and from 45.74% to 18.50%, respectively(p=0.0001). CONCLUSIONS: The overall prevalence of OAB in group A for Korean children 5-13 years of age was similar to that in group B. However, the range of prevalence in group B was much more variable than that in group A. NE, constipation, fecal incontinence, a history of urinary tract infection and delayed bladder control may be risk factors for OAB in children.

Vesicouterine Fistula Following Repeated Cesarean Section / 대한비뇨기과학회지

Vesicouterine fistula is a rare disease that comprises 1 to 4% of all reported urogenital fistulas. Repeated cesarean section may be related to the formation of vesicouterine fistula. We experienced a case of vesicouterine fistula, and the patient's symptom was gross hematuria during her mensturation period after repeated cesarean section.

Mesh Cutting after Midurethral Sling Procedure in Female Stress Urinary Incontinence: 1 Year Follow-up

PURPOSE: Midurethral sling procedure is widely used as a primary choice for managing female stress urinary incontinence(SUI) in many countries. But some complications are inevitable, although the incidence is very low. Mesh cutting may be required to correct unwanted problems in some patients. We evaluated the outcome of mesh cutting in patients having mesh-related complications. MATERIALS AND METHODS: Medical records of patients who underwent cutting of midurethral tape from January 2001 to December 2005 were reviewed and a detailed telephone interview was done to see if stress urinary incontinence recurred at least a year after cutting. RESULTS: Eleven patients were included in this study. Mean age was 51.2 ranging from 41 to 70. The reasons why their meshes should be cut were as follows; eight(72.7%) had voiding difficulty, two(18.2%) had a tape erosion and one had voiding difficulty and overactive bladder. These problems were corrected by mesh cutting except one. However, a year after cutting, four out of eleven patients(36.4%) developed recurrent stress urinary incontinence. Recurrence occurred in three out of five patients(60.0%) whose meshes were cut within 1 month after implant, while occurred in 1 out of 6(16.7%) whose meshes were cut after 2 months of implant. Three out of four patients(75.0%) who had mixed urinary incontinence developed recurrence after mesh cutting. In particular, two patients who had detrusor overactivity confirmed by cystometry before surgery showed recurrence of incontinence after mesh cutting. CONCLUSION: A total 36.4% of patients who required mesh cutting developed recurrence of SUI. These data demonstrate that mesh cutting may cause recurrence and urologists should be aware that mesh cutting may be disappointing. Mixed urinary incontinence and duration from implant to mesh cutting seem to be the risk factors of recurrence after mesh cutting.

The Changes of Storage Symptoms after Tension-free Vaginal Tape Procedures in Stress Urinary Incontinence Patients / 대한비뇨기과학회지

PURPOSE: We evaluated the changes of storage symptoms after tension-free vaginal tape(TVT) procedures in stress urinary incontinence(SUI) patients, and we investigated the factors predicting the changes of storage symptoms. MATERIALS AND METHODS: From January 2000 to August 2003, 713 patients with SUI were operated on with using suburethral sling procedures(TVT). A follow-up study was conducted for over a one year period with 495 patients. We analyzed the one year outcomes of TVT surgeries and the changes of storage symptoms after TVT. RESULTS: The rates of cure and improvements at one year after TVT were 80.8% and 12.3%, respectively. At one month after TVT, 59 of 180(33%) patients with urgency before TVT were improved, and 60 of 72(83.6%) patients with urgency incontinence before TVT were improved. In 86 of 180(47.8%) patients, the urgency is improved, and in 65 of 72(90.1%) patients, the urgency incontinence disappeared at one year after TVT procedure. Urgency developed in 65 of the 243(26.9%) patients who had no urgency before TVT, but after 1 year, only 28(10.2%, 25/243) these 243 patients had urgency. 102(31.6%) of the patients with frequency before TVT were improved after TVT. Of the 92 patients with nocturia, 22 (23.4%) patients were improved. There were no statically significant factors predicting the changes of the storage symptoms. CONCLUSIONS: The total improvement rate (cure+improvements) of stress urinary incontinence was 93.1% at one year. We can expect the improvement of urgency(47.1%) and urgency incontinence(90.1%) after TVT procedures, but not improvement of the frequency and nocturia.

Causes of Reoperation after Midurethral Sling Procedures in Female Stress Urinary Incontinence

PURPOSE: Midurethral sling procedure has become one of the most commonly performed procedures for the treatment of female stress urinary incontinence(SUI). Although complication rate is very low, some patients are required further treatment to correct unwanted problems after surgery as it continues to be more widely used. We evaluated the mesh-related complications in those who required further procedures after midurethral sling procedures. MATERIALS AND METHODS: From January 2000 to December 2005, female patients who underwent additional surgery because of complications after midurethral sling procedures for stress urinary incontinence were evaluated in this study. RESULTS: In 675 patients, 298 received a tension-free vaginal tape(TVT) and 377 received a Monarc(transobturator route, TOT) as a sling material at 3 different hospitals. 34(5.0%) out of 675 patients required additional surgery to correct complications including obstructive voiding symptoms, mesh extrusion, failed or recurred SUI, wound pain and mesh in the bladder. Mean age of 34 patients was 54.7, and TVT was used in 21(7.0%) out of 298 patients, Monarc was used in 12(3.4%) out of 377 as midurethral sling materials. In 19 patients who showed obstructive voiding symptoms, all were cured by mesh cutting and in 8 patients who complained of immediate recurrence of SUI, 7 showed complete dryness by shortening the loosen mesh. Mesh extrusion with vaginal erosion were observed in 3 and all were cured by segmental resection of mesh without recurrence of SUI. 2 patients who showed recurrence of SUI after 2 years of TVT received Monarc procedure. Mesh in the bladder which was found after 6 months of TVT was managed by endoscopic resection of mesh with Monarc procedure in 1, and suprapubic pain after TVT was improved by resection of TVT segment through suprapubic incision in 1. All reoperation procedures were performed by local anesthesia except 1(mesh in the bladder). CONCLUSION: These data demonstrate that midurethral sling is an excellent surgical procedure with low complication rate, high success rate in reoperation. However, care must be taken to reduce reoperation rate in applying tension of mesh on urethra because most patients(27 out of 34) who required reoperation have complained of obstructive voiding symptoms(19) and persistent incontinence(8).

Evaluation of diagnostic methods in children with nonpalpable undescended testis / 소아과

PURPOSE: Numerous methods exist for diagnosing nonpalpable testis in treatment of cryptochidism. However, there is no clinically established data for the rational diagnostic tool of nonpalpable testis in terms of expenses. We tried to establish a current conventional diagnostic course of nonpalpable testis. We then evaluated the efficacy of ultrasonography, physical examination under general anesthesia and laparoscopy for diagnosing nonpalpable testis. METHODS: Between March 2000 and February 2005, 103 boys(129 testes) with undescended testes were treated in our department. There were 31 testes(24.0%) that were not palpable at physical examination. These patients were evaluated with ultrasonography and repeated physical examination under general anesthesia. In the cases where testes could not be detected with ultrasonography and physical examination under general anesthesia, laparoscopy was performed to diagnose nonpalpable testis. RESULTS: In 31 cases of nonpalpable testis, 13 testes were detected with ultrasonography and 15 testes became palpable with physical examination under general anesthesia. All of the remaining 16 nonpalpable testes were confirmed with laparoscopy. CONCLUSION: Physical examination under general anesthesia was superior to ultrasonography in making a diagnosis of nonpalpable testis. Ultrasonography and physical examination under general anesthesia could reduce the incidence of diagnostic laparoscopy. Therefore, it is recommended that ultrasonography, physical examination under general anesthesia and laparoscopy must be performed conventionally in order to diagnose nonpalpable testis.

Clinical Outcome of Transobturator Monarc Procedures for Treating of Women with Stress Urinary Incontinence: The 2-Year Follow Up / 대한비뇨기과학회지

PURPOSE: The transobturator Monarc procedure is a new minimally invasive treatment for female stress urinary incontinence (SUI), and this is known to be safe and convenient because serious complications such as bladder or bowel perforation and vascular injury, which can happen during a tension-free vaginal tape (TVT) procedure, can be avoided and cystoscopic examination is not necessary. We evaluated the 2 year clinical outcome of transobturator Monarc sling procedures for female SUI. MATERIALS AND METHODS: There were 114 women who underwent the transobturator Monarc procedure for SUI at 3 different hospitals of The Catholic University of Korea from December 2003 to February 2004. After 2 years following surgery, all the patients were asked about their voiding symptoms as well as any recurrence by conducting detailed telephone interviews. RESULTS: For the 114 patients, 86 patients (75.4%) stated that they had complete resolution of SUI, and 22 patients (19.3%) stated they were continent with only a small amount of leakage when coughing. The overall success rate of the Monarc procedure was 94.7% (108/114). 36 (64.3%) out of 56 patients who had urgency or urge incontinence before surgery indicated the improvement of their symptoms following surgery. For 62 patients who had frequency, the symptom was improved in 48 patients (77.4%), and for the 44 patients who had nocturia, the symptom was improved in 32 (72.7%). CONCLUSIONS: These data demonstrates that the transobturator Monarc procedure is a safe and effective treatment for women with SUI, which is comparable with TVT, and the patients' voiding symptoms can be expected to be improved after the transobturator Monarc procedure as well. However, we do not know how long the improvement of the voiding symptoms will last, and so additional longer term follow-up should be done.

Mesh Cutting in Patients with Obstructive Symptoms after Tension-free Vaginal Tape Procedure

PURPOSE: Tension-free vaginal tape(TVT) procedure is widely used as an initial operative method in stress urinary incontinence because of high success rate and low morbidity. However, some patients have complained of voiding difficulties after TVT. We evaluated 14 patients who underwent mesh cutting because of obstructive symptoms after TVT. MATERIALS AND METHODS: 14 patients who underwent mesh cutting because of prolonged obstructive symptoms after TVT were included for the study. Their voiding symptoms were evaluated by Qmax, voiding time and postvoid residual urine. These parameters which were done before TVT, post-TVT and post-mesh cutting were compared. RESULTS: 4 out of 14 patients were intrinsic sphincter deficiency(valsalva leak point pressure <60 cmH2O) and no patient had detrusor overactivity before TVT. After TVT, Qmax was decreased from 25.4+/-3.5 ml/sec to 9.4+/-2.4 ml/sec, and voiding time was prolonged from 26.7+/-6.6 sec to 65.5+/-24.8 sec. However, the volume of postvoid residual urine was unchanged. After mesh cutting, Qmax was increased to 21.7+/-7.7 ml/sec and voiding time was decreased to 27.2+/-7.6 sec. Subjective voiding symptoms were improved immediately in 13 out of 14 patients(92.9%), although 1 patient showed small amount of urine leakage when coughing. And also, in 1 out of 2 patients, detrusor overactivity which was shown after TVT was disappeared. CONCLUSION: We believe that we do not need to hesitate to cut the mesh in patients who are suffering from severe obstructive symptoms after TVT.

Behavioral and Emotional Problems in Children with Nocturnal Enuresis: Results of a Multicenter Study / 신경정신의학

OBJECTIVES: The aim of this study was to examine the behavioral and emotional problems associated with nocturnal enuresis in Korean children. METHODS: Three hundred eighteen children with nocturnal enuresis, together with their parents, completed the Child Behavior Checklist (CBCL), Disruptive Behavior Disorder Scale according to DSM-IV (DBDS), Children's Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), and Piers-Harris Children's Self-Concept Scale (PHCSC). Ninety-three normal students were selected as the control group. RESULTS: Compared to the normal control group, the mean scores with regard to the withdrawn, social problems, attention problems, delinquent behavior, aggressive behavior, externalizing problems and total problems profiles were significantly higher in the nocturnal enuresis group according to the CBCL results. The nocturnal enuresis group also scored significantly higher in the ADHD and ODD profiles of the DBDS. The nocturnal enuresis group was more depressed and anxious than the control group according to the results of the CDI and STAI. The mean score of the PHCSC was significantly lower in the nocturnal enuresis group when compared to the normal control group. CONCLUSION: The results of this study suggest that children with nocturnal enuresis in Korea have clinically relevant behavioral and emotional problems. The findings support the link between nocturnal enuresis and psychopathology in Korean children.

Female Urethral Prolapse Treated by Simple Ligation over a Foley Catheter: A Case Report

Urethral prolapse is rarely diagnosed. We have reported a case of urethral prolapse that was successfully managed by a simple ligation of prolapsed urethra over a Foley catheter in a postmenopausal woman who was suffering from advanced lung cancer.

Efficacy of Bicalutamide Monotherapy in Locally Advanced Prostate Cancer / 대한비뇨기과학회지

PURPOSE: Nonsteroidal antiandrogen monotherapy may be a treatment option for some patients with locally advanced prostate cancer. We report the efficacy, advantage, and adverse events of bicalutamide monotherapy in patients with locally advanced prostate cancer. MATERIALS AND METHODS: We retrospectively reviewed 13 patients with locally advanced prostate cancer who were treated with bicalutamide 150mg monotherapy. Serum PSA reduction was evaluated with periodic PSA follow-ups. If clinical progression was suspected, pelvic CT or bone scan was performed for the evaluation of disease progression. The changes of sexual function were assessed with the IIEF questionnaires prior to treatment and after 6 months of medication. RESULTS: Serum PSA declined to less than 2ng/ml within 3 months after treatment in most patients. A high serum PSA level was maintained in only 1 patient, and this patient showed disease progression. There were no significant differences between the mean scores of the pretreatment and post-treatment erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction (p>0.05). Of the 13 patients, 2 patients (15.5%) showed adverse events, such as breast pain and gynecomastia. However, the symptoms were mild to moderate. There was no withdrawal to medication due to drug-related adverse events. CONCLUSIONS: From the viewpoint of the fall in serum PSA levels after 3 months, bicalutamide monotherapy was effective in the treatment of locally advanced prostate cancer. There were benefits to the patients in terms of the quality of life parameters, sexual function, and tolerability, which make bicalutamide monotherapy an attractive treatment option for patients with locally advanced prostate cancer. (Korean J Urol 2004;45: 108-113)

The Female Sexual Dysfunction in Overactive Bladder Patients / 대한비뇨기과학회지

Purpose: Female sexual dysfunction is defined as a disorder of sexual desire, arousal, or orgasm, and/or sexual pain, resulting in personal distress that impacts on the quality of life and interpersonal relationships. It is a compilation of problems that has both biological and psychosocial components and is multifactorial in its etiology. In this study, the female sexual dysfunction in overactive bladder (OAB) patients was evaluated. Materials and Methods: The subjects included 63 female who visited our health care center for health medical examinations without voiding symptoms (control group) and 37 female patients with OAB. All patients were asked to complete the Brief index of sexual functioning for women (BISF-W), which had been translated into Korean. The Beck depression inventory (BDI) and State-Trait anxiety inventory (STAI) were also used to assess the relationship between the sexual dysfunction and anxiety or depression. The results were analyzed statistically by ANCOVA using age as a covariant. Results: The mean ages in the OAB and control groups were 35.47+/-6.76 and 42.70+/-9.68 years, respectively. The mean scores of desire in the OAB and control groups were 3.92+/-3.09 and 8.92+/-4.99, for arousal were 6.78+/-3.85 and 11.06+/-5.60, frequency of sexual activity 3.92+/-5.24 and 8.53+/-4.52, receptivity/initiation 10.08+/-3.71 and 11.47+/-4.91, orgasm 13.19+/-6.97 and 19.72+/-7.36, relationship satisfaction 7.12+/-1.68 and 7.11+/-1.88 and physical problems affecting sexual function 12.14+/-6.17, 11.83+/-5.05, respectively. The OAB group shows decreased sexual desire, arousal, frequency of sexual activity and orgasm compared to the control group (p<0.05). However, there were no differences in anxiety or depression between the two groups and there was no sexual dysfunction due to anxiety or depression in either group. Conclusions: Female sexual dysfunction was more common in OAB patients than the controls. OAB is one of the important factor affecting female sexual dysfunction. Consideration should be given with regard to female sexual dysfunction in patients with OAB.

Is Evaluation with Voiding Cystourethrography Necessary for Children with a Febrile Urinary Tract Infection? / 대한비뇨기과학회지

PURPOSE: In the diagnosis of pediatric urinary tract infection(UTI), the use of invasive methods, such as voiding cystourethrography(VCUG), is controversial. A retrospective study was carried out to evaluate the necessity for VCUG in assessing pediatric UTI. MATERIALS AND METHODS: Between April 2000 and March 2002, 70 children (60 boys, 10 girls) with symptomatic UTI were evaluated. All patients were evaluated with renal ultrasonography(RUS), 99mTc-DMSA renal scintigraphy(DMSA renal scan) and VCUG. The results of the VCUG were compared with RUS and similar comparisons made between the results of the VCUG and DMSA renal scans. Patients with both normal a RUS and DMSA renal scan were then evaluated for the frequency and grade of vesicoureteral reflux(VUR) on the VCUG. RESULTS: The mean age at the initial evaluation was 7.95 months, ranging from 1 to 52 months. RUS and DMSA scan abnormalities were found in 38(54.3%) and 26(37.1%) children, respectively. Of the 22 patients with VUR confirmed by VCUG, 11(50.0%) had an abnormal RUS, and 12 (54.5%) patients had abnormal DMSA renal scans. Of the 19 patients with both a normal RUS and DMSA scan, 4(21.2%, 6 kidney-ureter unit) were found to have VUR on VCUG. CONCLUSIONS: This study illustrated that a considerable number of patients may have significant VUR, despite normal renal ultrasonography and DMSA scans. Therefore, VCUG remains important in assessing pediatric UTI.