Poor Preoperative Glycemic Control Is Associated with Dismal Prognosis after Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Korean Multicenter Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study is to evaluate the effect of diabetes mellitus (DM) and preoperative glycemic control on prognosis in Korean patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU). MATERIALS AND METHODS: A total of 566 patients who underwent RNU at six institutions between 2004 and 2014 were reviewed retrospectively. Kaplan-Meier and Cox regression analyses were performed to assess the association between DM, preoperative glycemic control, and recurrence-free, cancer-specific, and overall survival. RESULTS: The median follow-up period was 33.8 months (interquartile range, 41.4 months). A total of 135 patients (23.8%) had DM and 67 patients (11.8%) had poor preoperative glycemic control. Patients with poor preoperative glycemic control had significantly shorter median recurrence-free, cancer-specific, and overall survival than patients with good preoperative glycemic control and non-diabetics (all, p=0.001). In multivariable Cox regression analysis, DM with poor preoperative glycemic control showed association with worse recurrence-free survival (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.31 to 3.90; p=0.003), cancer-specific survival (HR, 2.96; 95% CI, 1.80 to 4.87; p=0.001), and overall survival (HR, 2.13; 95% CI, 1.40 to 3.22; p=0.001). CONCLUSION: Diabetic UTUC patients with poor preoperative glycemic control had significantly worse oncologic outcomes than diabetic UTUC patients with good preoperative glycemic control and non-diabetics. Further investigation is needed to elucidate the exact mechanism underlying the impact of glycemic control on UTUC treatment outcome.

Comparison of Erectile Dysfunction Treatment Efficacy of Mirodenalfil 50mg Once Daily and 100mg On-Demand in Patients with Benign Prostatic Hyperplasia and Erectile Dysfunction: Multicenter, Randomized

PURPOSE: To Compare the improvement of erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) as well as the efficacy of mirodenalfil 50mg once daily and 100mg on-demand in patients with benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). MATERIALS AND METHODS: Prospective study was done with 220 patients who had BPH and ED from June 2013 to October 2014. Out of 220 individuals, 260 met inclusion criteria and 204 finished the research. Patients were divided into two groups. Group 1 had mirodenafil 50mg once daily and Group 2 had mirodenafil 100mg on-demand. The five-item version of the International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), Qmax, and residual urine volume(PVR) were assessed immediately before initiation of treatment (V1) and after four (V2) and twelve weeks of treatment (V3). RESULTS: No difference of IIEF-5, IPSS, Qmax, and PVR between two groups in V1. At V3, both groups had improvements of IPSS and group 1 had better improvements (-5.1+/-4.4 vs. -3.1+/-3.9 p<0.001). And Group 1 had larger improvements than Group 2 in Qmax significantly. No difference in PVR in both groups comparing V1 vs. V2 and V1 vs V3. Group 1 had better improved IIEF-5 than Group 2 (V1 vs. V3: 4.8+/-5.8 vs. 4.4+/-5.1; p=0.032). There was no drop out patients due to cardiovascular problems. CONCLUSIONS: Once daily mirodenafil 50mg was more efficacious in treating both ED and LUTS than on-demand dosing mirodenafil 100mg without any complication of cardiovascular problems.

Long-term Outcome of the Readjustable Sling Procedure for Female Stress Urinary Incontinence With Intrinsic Sphincter Deficiency or Recurrence

PURPOSE: We evaluated the long-term outcome of a readjustable midurethral sling system (Remeex) in the treatment of recurrence of stress urinary incontinence (SUI) after surgical treatment or SUI with intrinsic sphincter deficiency (ISD). MATERIALS AND METHODS: This study included 19 patients who underwent the Remeex procedure with a mean of 45.6 months of follow-up. The patients had responded to a telephone questionnaire. Thirteen patients had ISD, four patients had SUI recurrence, and two patients had both. The questionnaire included subjective cure and satisfaction surveys and also recommended surgery to some patients. RESULTS: The mean patient age was 69.1 years (range, 50-85 years), the mean parity was 2.79 times (range, 2-5 times), and the mean follow-up period was 45.6 months (range, 21-72 months). The long-term follow-up cure rate was 79%, the improvement rate was 21%, and the fail rate was 0%. The long-term follow-up "very satisfactory" rate was 26.3%, the "satisfactory" rate was 73.7%, and the "usual" and "unsatisfactory" rates were both 0%. In addition to these results, 16 patients (84.2%) would recommend the Remeex procedure to other patients with SUI recurrence or ISD. After the procedure, four patients had urinary retention, three patients had difficulty emptying, and one patient had SUI recurrence. Furthermore, all of the patients subsequently endured sling readjustments. CONCLUSIONS: After long-term follow-up, the Remeex system showed good cure rates and subjective satisfaction rates that were similar to the results found at the 1-year follow-up, and minimal complications were reported. Therefore, the Remeex system is effective in treating patients with SUI recurrence or ISD.

Therapeutic Efficacy of Bipolar Radiofrequency Thermotherapy for Patients with Chronic Prostatitis: A Retrospective Analysis of 26 Cases

PURPOSE: Chronic prostatitis (CP) does not yet have a universally successful therapy. Alternative treatments including thermotherapy have been adopted in the multimodal management of pain and voiding dysfunction. We retrospectively analyzed the therapeutic efficacy of bipolar radiofrequency thermotherapy for patients who were unsatisfied with conventional medication for CP. MATERIALS AND METHODS: A retrospective study between October 2009 and September 2010 of 26 patients who were under 50 years old and diagnosed with CP (National Institutes of Health [NIH]-category III) was performed. Twenty patients were diagnosed with inflammatory CP (NIH-category IIIa) and the rest with noninflammatory CP (NIH-category IIIb). We used the Tempro system at an intraprostatic temperature of 55degrees C for 50 minutes with a medium heating rate. All patients also completed the NIH-Chronic Prostatitis Symptom Index (CPSI) before and after treatment. RESULTS: In the patients diagnosed with CP, the mean serum prostate-specific antigen (PSA) level was 0.9+/-0.3 ng/ml, the prostate volume was 27.1+/-5.5 g, and the average score for all 3 domains on the NIH-CPSI significantly decreased. The total scores decreased from 19.8+/-7.1 to 11.1+/-7.0, the pain domain decreased from 8.6+/-3.1 to 4.8+/-3.1, the voiding symptom domain decreased from 5.1+/-1.8 to 2.9+/-1.8, and the effect on the quality of life decreased from 6.1+/-2.2 to 3.4+/-2.2 (p<0.05). CONCLUSIONS: Bipolar radiofrequency thermotherapy for patients with CP intractable to conventional medication can provide significant improvement in the NIH-CPSI. Large, randomized controlled trials will also be required to confirm the efficacy of this therapy.

Readjustable Sling Procedure for the Treatment of Female Stress Urinary Incontinence with Intrinsic Sphincter Deficiency: Preliminary Report

PURPOSE: The Remeex (Mechanical External Regulation) sling is a mid-urethral sling that allows adjustment of the sling tension in the postoperative period. We evaluated the early outcomes of the procedure in patients in whom the success rate of tension-free slings is low, such as with intrinsic sphincter deficiency (ISD). MATERIALS AND METHODS: We included 17 women with urodynamically proven stress urinary incontinence (SUI) who underwent the Remeex procedure and were followed for at least 12 months. The patients were considered to have ISD on the basis of a Valsalva leak point pressure (VLPP) <60 cmH2O or a maximum urethral closure pressure (MUCP) <20 cmH2O. We analyzed parameters including history taking, urodynamic study (UDS), and postoperative clinical outcomes. Patient's success and satisfaction rates were evaluated after the procedure. Also, we asked about lower urinary tract symptoms (LUTSs) with a questionnaire, and the severity of LUTSs was assessed with the Visual Analog Scale (VAS) before and 12 months after the operation. RESULTS: The patients' mean age was 55.6+/-9.58 years. Four (23.5%) patients had mixed incontinence. Five patients (29.4%) had undergone previous surgery for SUI. At a mean follow-up of 13.3 months (range, 12-16 months), 14 patients (82.3%) were cured and 3 patients (17.6%) were improved. Four patients (23.5%) answered very satisfied and 13 patients (76.4%) answered satisfied on the satisfaction questionnaire. Also, LUTSs were improved except voiding pain (p<0.05). CONCLUSIONS: This procedure provides high cure and satisfaction rates. Our results demonstrate that the Remeex procedure is suitable for women with SUI with ISD.

Comparison of Cost and Clinical Outcome for Ureteral Stones Larger than 1cm; Extracorporeal Shock Wave Lithotripsy versus Ureteroscopic Lithotripsy / 대한비뇨기과학회지

PURPOSE: To compare extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic removal of stone (URS) on the basis of success rate, cost effectiveness, safeness, cause of failure, complication, and auxiliary procedures in treating ureteral stones larger than 1cm. MATERIALS AND METHODS: From January 2001 to April 2005, 72 cases were treated with URS using 7.5Fr or 9.5Fr rigid ureteroscopy and 110 cases with in situ Direx Compact ESWL. The mean stone sizes of URS and ESWL were 12.8mm and 13.1mm, respectively, and all were larger than 10.0 mm. RESULTS: In the URS, the overall success rate and the mean operative time were 88.9% (64/72 cases) and 68 minutes, respectively. According to stone site, the success rates of upper, mid and lower ureteral stones were 83.3% (15/18 cases), 84.6% (11/13 cases) and 92.6% (38/41 cases), respectively. The first session and total treatment, stone-free rates for ESWL were 34.5% (38/110 cases) and 79.0% (87/110 cases), respectively. The complication rates associated with URS and ESWL were 13.8% (10/72 cases) and 11.8% (13/110 cases), respectively. All complications were managed successfully with conservative treatment. Overall costs were similar for both modalities, but detailed cost analysis (e.g. follow-up loss patient) was not performed. CONCLUSIONS: Both URS and ESWL are effective treatments for stones larger than 1cm, but ureteroscopy with intracorporeal lithotripsy is the more efficient and cost effective method.

Short Term Results of Tension-Free Vaginal Tape Procedure with Vaginal Hysterectomy / 대한비뇨기과학회지

Purpose : To evaluate the short term result of the tension-free vaginal tape (TVT) procedure in conjunction with vaginal hysterectomy in patients with concurrent stress incontinence and gynecological diseases. Materials and Methods: All patients (32 women) underwent the TVT procedure in conjunction with vaginal hysterectomy between June 2001 and April 2003. Preoperative histories, subjective questionnaires of the degree of incontinence, physical examinations, one hour pad tests and full urodynamic testing were evaluated. The postoperative clinical outcomes, patient satisfaction and complications were checked after 3-months. Results: Thirty-two women who met the study criteria were identified. The mean follow-up time, parity, age, operating time and length of hospital stay were 9.2 months, ranging from 3 to 18 months, 2.6, ranging from 1 to 5, 52.5 years, ranging from 40 to 68, 73 minutes, ranging from 55 to 122 minutes and 4.3 days, ranging from 3 to 9 days, respectively. From the questionnaires, 22 patients were found to be mildly incontinent, 7 moderately incontinent and 3 severely incontinent. All patients were cured of gynecological disease. All cases of mild, 5 of moderate and 2 of severe incontinence were cured. The three remaining patients improved. Twenty-eight patients were satisfied after the operation and 1 had intraoperative bladder perforation. Conclusions: The TVT procedure in conjunction with a vaginal hysterectomy for stress incontinence with other gynecologic disease is considered safe and efficacious, although a longer follow-up will be necessary to determine the long term effect.

Metastatic Ureteral Tumor from the Lung Squamous Cell Carcinoma after Complete Remission / 대한비뇨기과학회지

Ureteral tumors are relatively uncommon, accounting for approximately 1.2% of all urothelial tumors. Metastatic ureteral tumors are even rarer. The primary lesions include breast, melanomas, bladder, colon, stomach, lung, and esophageal, prostate, ovarian, kidney, urethral and vaginal carcinomas. Patients usually have lumbar or flank pain, dysuria, frequency, and in the latter stages, anuria. We report a case of a metastatic ureteral tumor from a lung squamous cell carcinoma after complete remission.

Fibrous Pseudotumor of Paratesticular Region / 대한비뇨기과학회지

A fibrous pseudotumor of the paratesticular region is rare, but one of the most common neoplasma of this area. It has also been called a nodular fibrous proliferation, pseudofibromatous periorchitis, benign fibrous paratesticular tumor, and fibrous mesothelioma (pseudofibroma). Complete surgical excision, by orchiectomy, appears to be curative. A case of a fibrous pseudotumor is reported and the clinical presentation and radiographic and histological findings described.

Comparison of Ureteroscopic Lithotripsy and Extracoporeal Shock Wave Lithotripsy in the Treatment of Upper Ureteral Stones / 대한비뇨기과학회지

PURPOSE: Cases of ureteroscopic lithotripsy (URS) were retrospectively reviewed to define the efficacy of an ureteroscopic lithotripsy in the treatment of upper ureteral stones. The success rates, reasons for failure and complications of URS were compared with extracoporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: URS for upper ureteral stones was performed in 48 cases, between January, 2000 and December, 2002. A 7.5Fr, or 9.5Fr, rigid ureteroscopy and stone basket were used with, or without, electrohydraulic lithotripsy. There were 29 males and 19 females, with a mean age of 43.3 years. RESULTS: The overall success rate of the URS was 91.6%. According to the stone size, the success rates were 92.1 and 90% in stones smaller than 10mm and larger than 10mm, respectively. With the ESWL treatments, the overall stone free rate was 71.7% with only one session. The stone free rate was significantly affected by the size, was and were 77.9 and 46.3% in stones smaller than 10mm and larger than 10mm, respectively. The stone free rate after the second and third ESWL sessions were 81.3 and 91.3%, respectively. The associated complication rate for URS was 18.1%, with the complications consisting of ureteral mucosal injuries in 3 patient, flank pain (>48 hours) in 2, a ureteral perforation in 1, fever in 1 and a gross hematuria (>48 hours) in 1, which were all treated successfully with conservative treatment. CONCLUSIONS: URS can be a successful and safe treatment modality for upper ureteral stones, even if larger than 10mm.

Idiopathic Retroperitoneal Fibrosis Treated with Medical Therapy / 대한비뇨기과학회지

Retroperitoneal fibrosis, although benign, has a malignant course due to an encasement and obstruction of the retroperitoneal structures, particularly the urinary system. The most common treatment is often a surgical exploration followed by urologic intervention. However, steroid or azathioprine therapy has been advocated, with varying results and major side-effects. Recently, the successful medical therapy in patients with an early stage and low malignant potential has been reported. Here we report a male patient who underwent successful treatment of an idiopathic retroperitoneal fibrosis with tamoxifen and prednisolone.

A Case of Priapism Caused by Malignant Lymphoma / 대한비뇨기과학회지

Priapism is a relatively rare condition of prolonged painful penile erection, unrelated to sexual activity. It is caused by idiopathic, leukemia, sickle cell disease, oral medication, intracavernosal injection therapy, spinal cord injury and malignant cell infiltration. Malignant lymphoma involving the genitourinary system is uncommon and when it occurs the testes is the most common site. However malignant lymphoma involving the penis is even more rare, with only 20 cases reported in literature. To our knowledge, priapism caused by penile lymphoma has not been reported previously in literature. We report a case with a brief review of literature.

Clinical Experience of the 121 Patients with Testis Tumors / 대한비뇨기과학회지

PURPOSE: A multicenter study was performed to evaluate the clinical characteristics and the results of chemotherapy in patients with testicular tumor. MATERIALS AND METHODS: We retrospectively reviewed the records of 121 patients with testicular tumor treated at five university hospital between 1980 and 1997. We analyzed the clinical characteristics, additional treatments after orchiectomy and results of chemotherapy. RESULTS: Patients age ranged from 1 month to 74 years with a mean of 24 years. The common presenting symptoms were scrotal swelling in 63 patients, palpable mass in 50, and testicular pain in 12. The location of the tumor was on the right side in 62, left in 58, and both in 1 with lymphoma. The histologic type was germinal neoplasm in 101 patients, nongerminal neoplasm in 1, and other tumors in 19. Clinically, 76 patients(62.8%) were stage I, 16(13.2%) stage IIa, 12(9.9%) stage IIb, 3(2.5%) stage IIc, 9(7.4%) stage III and 5(4.1%) stage IV. After orchiectomy, 73 patients(60.3%) were underwent close observation, 30(24.8%) chemotherapy, 14(11.6%) radiation therapy, 3(2.5%) radiation plus chemotherapy and 1(0.8%) retroperitoneal lymph node dissection. Among the 33 chemotherapy patients, 12(36.4%) patients achieved a clinical complete remission(CR), 5(15.2%) partial remission(PR), 4(12.1%) minor response and stabilization, 5(15.2%) progression and 7(21.2%) patients were follow-up loss, and the overall clinical response rate was 65.4%. Among the 18 chemotherapy patients with nonseminomatous germ cell tumor(NSGCT), 9(50.0%) patients achieved a clinical CR, 4(22.2%) PR, 1(5.6%) minor response and stabilization, 2(11.1%) progression and 2(11.1%) patients were follow-up loss, and the overall clinical response rate was 81.3%. CONCLUSIONS: Our study group was relatively small and insufficient to evaluate the chemotherapeutic results, but NSGCT seems to have a better clinical response to chemotherapy.

The Effect of Spinal Cord Injury on Pituitary-Testicular Hormone Axis in Rats / 대한비뇨기과학회지

PURPOSE: To investigate the effect of spinal cord injury(SCI) on male reproductive function, we evaluated changes of pituitary-testicular hormonal level at various time intervals in spinal cord injured rats. MATERIALS AND METHODS: SCI was produced in 30 sexually mature Sprague-Dawley rats by T10 spinal cord transection. 20 controls received similar surgery without transection. Testosterone concentrations in the serum and testis, serum levels of follicle-stimulating hormone(FSH) and leutenizing hormone(LH) were measured with radioimmunoassay. Two way analysis of variance(ANOVA) was performed. RESULTS: Testosterone levels in the serum and testis were lower at 2 weeks after injury than in controls, but others were not. Serum levels of FSH and LH were similar in both group. CONCLUSIONS: Spinal cord injury in rats induced impairment of testosterone production in testis at 2 weeks.

A Case of Urethral Construction Using Paraexstrophy Flap in Newborn female with Classical Exstrophy / 대한비뇨기과학회지

Primary closure of bladder exstrophy in a one-day-old-girl was performed with paraexstrophy skin flap and pubic bone approximation without osteotomy.

Availability of Percutaneous Drainage in the Treatment of Emphysematous Pyelonephritis / 대한비뇨기과학회지

PURPOSE: The therapeutic approach to patients with emphysematous pyelonephritis long has been a debatable issue. So we evaluated the efficacy of percutaneous drainage in patients with emphysematous pyelonephritis. MATERIALS AND METHODS: 7 patients with emphysematous pyelonephritis underwent percutaneous drainage. The result was classified as cure, partial success, recurrence, or failure. The mean drainage period and complication were analyzed. RESULTS: There were 2 men and 5 women with 49 to 72 years old(mean age 60) suffering from diabets mellitus. Six patients(87.5%) were cured with percutaneous drainage and antibiotics, but one patient who had diffuse renal parenchymal destruction without perirenal fluid collection was failed. The mean catheterization Period was 26.3 days(range 10 to 45). Bacteremia after percutaneous drainage in one patient was cured with antibiotic therapy. CONCLUSIONS: Percutaneous drainage can be a lifesaving alternative method in critically ill, high risk patient with emphysematous pyelonephritis.

The Efficacy of Combination Therapy of 5 alpha -Reductase Inhibitor and of-Adrenergic Blocker in Benign Prostate Hyperplasia / 대한비뇨기과학회지

PURPOSE: Benign prostate hyperplasia(BPH) can be treated with alpha1-adrenergic blocker that relaxes prostate smooth muscle or 5 alpha-reductase inhibitor that reduces serum dirtydrotestosterone. The efficacy of the combination of 5 alpha -reductase inhibitor(finasteride) and alpha1-adrenergic blocker(doxazosin) was evaluated in patients with benign prostate hyperplasia. MATERIALS AND METHODS: Eighty five patients with BPH was treated and followed over 6 months and divided into three groups: Group 1(doxazosin 3mg/day), Group 2(finasteride 5mg) and Group 3(combination of both drugs). Initially, all patients were evaluated by international Prostatic Symptom Score(IPSS: irritative, obstructive, sum, life quality), uroflowmetry, residual urine, serum prostate specific antigen(PSA) and prostate weight by transrectal ultrasonography. IPSS, uroflowmetry and complications were evaluated every month. Residual urine and PSA were assessed at every 3 months, prostate weight at every 6 months. RESULTS: In Group 1 and 3, IPSS were more decreased than In Group 2 immediately(p < 0.001). In Group 1 and 3, maximal flow rate was more increased than in group 2 immediately(p < 0.001). There was no difference of mean change of residual urine among three group. In Group 2 and 3, serum prostate specific antigen and prostate weight were more decreased than in Group 1 (p < 0.001). CONCLUSIONS: In medical treatment of BPH, the combination therapy of alpha1-adrenergic blocker and 5alpha-reductase inhibitor shows early symptomatic improvement and decreased prostate weight without significant complications.

The Effect of Spinal Cord Injury on Spermatogenesis in Rats / 대한비뇨기과학회지

Male infertility occurs after spinal cord injury (SCI). However, little is known about the effect of SCI on male reproductive function. We evaluated objective assessment of spermatogenesis of spinal cord injured rats by quantitative micrometry and DNA flow cytometry analysis at various time intervals. SCI was produce(B in 30 rats by 710 spinal cord transection. Controls received similar surgery without transaction. From 10 randomly selected seminiferous tubules per subject the mean number of mature spermatids, Sertoli cells, tubular diameter and tubular wall thickness were determined in both groups. The percentage of haploid, diploid and tetraploid cells were determined of each subject by DNA (low cytometry, Two way analysis of variance (ANOVA) was performed. In the SCI rats the mean number of spermatid per tubule was significantly lower (p=0.01) than that of controls. The mean number of Sertoli cells per tubule was not different from that of controls. Mean of spermatid to Sertoli cell ratio per seminiferous tubule in SCI rats was significantly lower than in controls (p=0.048). No significant differences of tubulr wall thickness, diameter and percentage of haploid cells were noted between both groups. These results suggest that the effect of SCI on spermatogenesis is associated with inadequacy of spermatid formation and maturation delay of spermatid.