False-Positive Elevation of Creatine Kinase MB Mass Concentrations Caused by Macromolecules in a Patient who Underwent Nephrectomy for Renal Cell Carcinoma

No abstract available.

Pseudo-Renal Failure; Urinary Ascites and Uremia due to Bladder Rupture / 대한신장학회지

The main feature of acute renal failure is a decline in the glomerular filtration rate. However, urine leakage into the peritoneal cavity due to bladder rupture may cause pseudo-renal failure. This is a situation in which renal function is normal, along with the presence of elevated serum creatinine. A 47-year-old woman presented with abdominal distension and pretibial pitting edema on both lower extremities. She had no traumatic history. She did not complain of abdominal pain, and exhibit neither oliguria nor anuria. Her blood urea nitrogen (BUN) and serum creatinine was 105 and 11.2 mg/dL. Ascites showed that urea nitrogen and creatinine were 160 and 29 mg/dL, respectively. We confirmed bladder rupture by an abdominal CT scan and retrograde cystography. She underwent an emergency laparotomy to repair the ruptured bladder. Azotemia was normalized 2 days after the operation. Here we present a rare case of uremia due to bladder rupture.

Prevalence of Premature Ejaculation in Chronic Pelvic Pain Syndrome / 대한남성과학회지

PURPOSE: Premature ejaculation is a common male sexual dysfunction and has an adverse effect on QoL(quality of life). Chronic pelvic pain syndrome(CPPS) is also a common and serious health problem affecting QoL. Although both disorders are common their etiopathogeneses are not well understood. We investigated the prevalence and effect of premature ejaculation on erectile function in CPPS patients and compared these patients with healthy control subjects. MATERIALS AND METHODS: 638 CPPS patients and 102 healthy controls were enrolled in this study. Each patient was given a questionnaire consisting of 3 parts: a demographic data questionnaire, the Korean version of the NIH-CPSI(National Institutes of Health-Chronic Prostatitis Symptom Index), and IIEF(International Index of Erectile Function). Premature ejaculation was defined as intravaginal ejaculation latency of less than 3 minutes with the same partner for at least 6 months. RESULTS: 303 patients with CPPS and 83 healthy controls were eligible for the analysis. The rate of premature ejaculation was much higher in patients with CPPS(71.62%) than healthy controls(22.89%), and this difference was statistically significant(p < 0.01). In the patients with CPPS, the frequency of sexual intercourse per month during the last 3 months was 4.79+/-3.43. In the patients with CPPS, the mean scores for IIEF-EF(erectile function), IIEF-IS(intercourse satisfaction), IIEF-OF(orgasmic function), IIEF-SD(sexual desire) and IIEF-OS(overall satisfaction) were 21.7+/-6.4, 8.5+/-2.9, 7.4+/-2.5, 5.3+/-2.0 and 5.2+/-2.1, respectively. Each mean IIEF domain score was lower than healthy controls, and these differences were statistically significant. But in the patients with CPPS categorized in IIIa and IIIb, the frequency of sexual intercourse and each IIEF domain score showed no difference. CONCLUSIONS: The rate of premature ejaculation was higher in the patients with CPPS than healthy controls.

Comparative Analysis of Clinical Parameters in Acute Pyelonephritis / 대한비뇨기과학회지

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

CD98 Activation Increases the Invasion of Human Breast Carcinoma MCF-7 Cells / 체질인류학회지

CD98, a disulfide-linked 125-kDa heterodimeric type II transmembrane glycoprotein, regulates the func-tions of beta1 integrin, suggesting that it may play a role in tumor cell invasion. In this study, the effects of CD98 signaling on the adhesion and invasion of tumor cells were investigated. The expression of CD98 on MCF-7 human breast carcinoma cells was confirmed by immunohistochemistry. The effects of CD98 activation on the adhesion to extracellular matrix (ECM) and invasion of MCF-7 cells were determined by adhesion assay and cell invasion assay. Dominant negative forms of focal adhesion kinase (FAK) were transiently transfected into MCF-7 cells using liposome reagents. CD98 stimulation increased the adhesion of MCF-7 cells to fibronectin, laminin and collagen IV. Activation of CD98 augmented the invasion rate of MCF-7 cells through ECM. EDTA or a function-blocking anti-beta1 integrin mAb suppressed the effect of CD98 on invasiveness. Inhibition of phosphorylation of FAK by PP2, an inhibitor of Src family kinase, reduced CD98-induced invasion of MCF-7 cells. This result was confirmed by over-expression of dominant negative forms of FAK. In addition, cytochalasin D or phalloidin inhibited CD98-mediated induction of tumor cell invasion. Inhibitory effects of PP2, cytochalasin D or phalloidin on CD98-stimulated invasion of MCF-7 cells were diminished by pretreatment of cells with Mn++, which is shown to induce conformational change of beta1 intgerin. These results provide the first evidence that CD98 activation increases tumor cell invasion by activating beta1 integrin affinity, and that FAK phosphorylation and subsequent cytoskeletal reorganization may be essential for CD98-mediated regulation of cell motility.

Clinical Outcome of Acute Bacterial Prostatitis, a Multicenter Study / 대한비뇨기과학회지

PURPOSE: Few studies have examined acute prostatitis in Korea. To initiate the investigation of this topic, a multi-center retrospective analysis of acute prostatitis was conducted. MATERIALS AND METHODS: The clinical records of 335 patients from 13 hospitals, diagnosed with acute prostatitis, between January of 1994 and October of 2004, were reviewed. For each patient, the urine culture, changes in the PSA (prostate-specific antigen) value and the prostate volume, the incidence of prostate abscess, the use of antibiotics, and whether the disease went into remission or progressed to chronic prostatitis were analyzed. RESULTS: The mean age of the patients, time from the onset of symptom to admission and number of days of admitted were 54.9+/-15.1 (16-85) years, 2.4+/-3.4 (16-85) days and 7.5+/-3.9 (1-25) days, respectively. The chief symptoms of the patients were high fever, dysuria and urinary frequency. Routine urinalysis found pyuria in 82% and hematuria in 70% of patients. The causative organisms of 43.0% of the patients were cultured, with the chief organisms found to be E. coli (67%) and P. aeruginosa (13%), et al. The mean PSA and prostate volume on initial diagnosis were 24.6+/-30.2ng/ml and 45.8 +/-17.4ml, respectively, and a prostate abscess was found in 4 patients (3.1%). The antibiotics injected during patient admission were: cephalosporin family (68%), aminoglycosides (70%) and quinolone family (43%). An additional alpha blocker was used in 49% of cases. Oral quinolone (91%), cephalosporin (9%) and alpha blocker (44%) were prescribed for a mean 32.5 (2-180) days after discharge. 259 (77%) of the patients were available for follow-up. Of these, 21% took antibiotics over an 8 week treatment period, and 8% over a 12 week period. The disappearance of pyuria after treatment was observed in a mean of 13 days after the end of treatment. After 13 weeks of treatment, 11 (50%) of the 22 patients who received prostate massage (4.2% of all follow up patients) were found to have chronic prostatitis. The mean PSA and prostate volume declined during follow up, to 6.13+/-10.38ng/ml and 37.5+/-13.5ml, respectively. CONCLUSIONS: In our study, the most common chief symptom of acute prostatitis was a high fever, with the most common causative organism being E. coli. Patients were admitted for approximately one week, and treated with antibiotic for about one month, after which time PSA elevation was observed in 80% of patients. Although all acute prostatitis patients were treated with proper antibiotics, progression to chronic prostatitis was observed in 4.2% of patients.

Holmium:YAG Laser Coagulation in the Female Patients of Voiding Symptom with Pseudomembranous Trigonitis

PURPOSE: Pseudomembranous trigonitis is a common cystoscopic finding in the female patients with voiding symptoms. We evaluated the changes in voiding symptoms of the patients after coagulating this lesion with Holmium:YAG laser. MATERIALS AND METHODS: Six female patients with voiding symptoms including frequency, dysuria, lower abdominal pain who were refractory to the conservative treatment for more than 1 month were enrolled in this study. The mean age was 35(range: 26~43) years. The patients were treated with cystoscopic evaluation and Holmium:YAG laser with 365 and 500 micrometer probe fibers. Power setting was between 6 and 11 watts. Only the lesions at the trigone and bladder neck were coagulated. No indwelling urethral catheter was used postoperatively. We evaluated patient's symptoms with out-patient follow-up or telephone up to 16 months. RESULTS: The mean duration of symptoms were 3.8(range: 6 months~13 years) years, and the mean follow-up was 13.3(range: 8~16) months. In all cystoscopic evaluations, pseudomembranous trigonitis was seen. After treatment, 3 of the 6 patients showed symptomatic improvements within 3 months and retained the improved state up to the last follow-up period. However, in the other 3 patients, no change in symptoms or initial response with following recurrence was seen. In the 3 patients who showed good response, transient worsening period of 1~3 months preceded the improvement. Follow-up cystoscopy at 3 months showed complete regeneration of the trigone and bladder neck mucosa. CONCLUSION: In the patients of pseudomembranous trigonitis with voiding symptoms refractory to conservative therapy, laser coaulation of the trigonal lesion was not so satisfactory but may be one of therapeutic options. Further investigation is needed.

Ureteroscopic Lithotripsy with the Holmium: YAG Laser / 대한비뇨기과학회지

PURPOSE: Holmium: YAG laser (Ho: YAG laser) lithotripsy represents an additional option in the management of urinary tract calculi. We report here on the results for the success and complications of Ho: YAG laser lithotripsy on the management of ureteric calculi. MATERIALS AND METHODS: 132 patients (72 males and 60 females, mean age: 46 years (range: 26-75)) underwent 137 ureteroscopic procedures using a 6/7.5Fr semi-rigid ureterocope (Wolf, Germany). A Ho: YAG laser (Trimedyne Inc., Irvine, USA) was used for laser lithotripsy at a maximum energy of 1.0J/pulse at 10Hz. The calculi were located in the lower ureter in 93 cases, the middle ureter in 20 cases and the upper ureter in 24 cases. The patients were assessed with plain x-ray within 4 weeks postoperatively. RESULTS: The overall stone-free rate was 98%. Stratifying the results by location, the stone-free rate was 99% in the lower ureter, 95% in the middle ureter and 96% in the upper ureter. Fragmentation failed in three cases (2%). Ureteral stricture developed in one case postoperatively. CONCLUSIONS: Ho: YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.

Ureteroscopic Lithotripsy with the Holmium: YAG Laser / 대한비뇨기과학회지

PURPOSE: Holmium: YAG laser (Ho: YAG laser) lithotripsy represents an additional option in the management of urinary tract calculi. We report here on the results for the success and complications of Ho: YAG laser lithotripsy on the management of ureteric calculi. MATERIALS AND METHODS: 132 patients (72 males and 60 females, mean age: 46 years (range: 26-75)) underwent 137 ureteroscopic procedures using a 6/7.5Fr semi-rigid ureterocope (Wolf, Germany). A Ho: YAG laser (Trimedyne Inc., Irvine, USA) was used for laser lithotripsy at a maximum energy of 1.0J/pulse at 10Hz. The calculi were located in the lower ureter in 93 cases, the middle ureter in 20 cases and the upper ureter in 24 cases. The patients were assessed with plain x-ray within 4 weeks postoperatively. RESULTS: The overall stone-free rate was 98%. Stratifying the results by location, the stone-free rate was 99% in the lower ureter, 95% in the middle ureter and 96% in the upper ureter. Fragmentation failed in three cases (2%). Ureteral stricture developed in one case postoperatively. CONCLUSIONS: Ho: YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.

Combination Therapy of Intraurethral Condyloma Acuminatum with Holmium: YAG Laser and 5-Fluorouracil Instillation / 대한남성과학회지

PURPOSE: Condyloma acuminatum is a common sexually transmitted disease of the external genitalia and anus. Approximately 5% of patients demonstrate urethral involvement. Electrical fulguration or excision using a pediatric resectoscope has been used in the management of such lesions. Holmium(Ho):YAG laser, 5-FU(fluorouracil), or interferon may be helpful in eradicating them. We reviewed the results of intraurethral condyloma acuminatum treatment with Ho:YAG laser and 5-FU solution. MATERIALS AND METHODS: From January 2001 to July 2002, seven patients with intraurethral condylomata acuminata were enrolled in the study. The mean age of the subjects was 19.5(range 25~43) years. Under local anesthesia with 10% lidocaine spray and jelly, all of the intraurethral lesions were removed with the Ho:YAG laser followed by coverage with 10mL of 5% 5-FU solution. Intraurethral injection of 5-FU was performed weekly up to six times. Urethroscopy for detection of recurrence was done 3 months after initial laser therapy. RESULTS: Most patients had multiple intraurethral lesions. Six patients (86%) responded to initial therapy without local recurrence with a mean follow-up of 15.8 (range 9.1-23.2) months. One patient had a recurrence at 2 months. CONCLUSIONS: We believe that the Ho:YAG laser plus 5% 5-FU solution is a useful option for the treatment of intraurethral condyloma acuminatum.

Effects of Finasteride on Hemospermia / 대한남성과학회지

PURPOSE: We evaluated the therapeutic efficacy of finasteride in the treatment of hemospermia, especially in prostatitis-related hemospermia. MATERIALS AND METHODS: Among the patients who visited our urologic department due to hemospermia from Jan 2000 to Oct 2003, 46 patients enrolled in the study. Semen analysis, expressed prostatic secretion, and transrectal ultrasonography were performed for all patients, and we determined whether or not the hemospermia was caused by inflammatory chronic non-bacterial prostatitis. We sorted all the subjects into 2 groups by the use of finasteride or not. We sub-divided the 2 groups by the presence or absence of prostatitis. In each of the 4 groups, the results were compared. Results were also recalculated after excluding sonographically abnormal cases. RESULTS: In the 35 finasteride-treated patients, the prostatitis group showed a 75% (12/16) success rate whereas the non-prostatitis group showed 31.6% (6/19) success. This difference was statistically significant (p=0.01). In the 11 non-finasteride patients, there was no difference in success rate between the prostatitis group (57.1%) and non-prostatitis group (50.0%). After excluding 15 sonographically abnormal patients, the finasteride-prostatitis group showed an 80% (8/10) success rate whereas the non-prostatitis group showed a 25% (3/12) success rate. CONCLUSIONS: Finasteride treatment in hemospermia was more successful in prostatitis than non-prostatitis patients. Efficacy was more prominent after excluding sonographically abnormal cases. Finasteride could be an useful agent in the treatment of prostatitis-related hemospermia. More extensive study is needed.

Seminal PSA and Sperm Motility in Inflammatory Chronic Non-Bacterial Prostatitis/Chronic Pelvic Pain Syndrome / 대한남성과학회지

PURPOSE: Prostate specific antigen(PSA) is present in a 10(6)-fold higher concentration in semen than in plasma, but serum PSA is elevated during inflammatory conditions such as chronic prostatitis. We evaluated the seminal PSA and its effect on sperm motility in inflammatory chronic nonbacterial prostatitis/chronic pelvic pain syndrome(CPPS). MATERIALS AND METHODS: Twenty-three patients with inflammatory CPPS(group P) and 11 normal controls(group NL) were enrolled in this study. The semen analysis was performed with a computerized analyzer, and seminal PSA was measured twice using a ELSA-PSA2 radioimmunometric kit(Cis Biointernational). We compared the result in groups P and NL. The subjects were then re-sorted into two groups according to the seminal PSA concentration, with 3.0 mg/ml as the cutoff value, and sperm motility was compared for the high- and low-PSA groups. Statistical significance was measured using the unpaired t-test. RESULTS: The average concentrations of seminal PSA in groups P and NL were 3.67 mg/ml and 1.79 mg/ml, respectively(p=0.048). Sperm motility was not different in the two groups. However, motility(straight-line velocity and average path velocity) was lower in the patients with high seminal PSA(p<0.05). CONCLUSIONS: Inflammatory chronic non-bacterial prostatitis increases the seminal secretion of PSA, and high seminal PSA is correlated with decreased sperm motility.

Characteristic Symptoms of Chronic Prostatitis/Chronic Pelvic Pain Syndrome / 대한비뇨기과학회지

PURPOSE: Chronic prostatitis/chronic pelvic pain syndrome (CPPS) presents various symptoms, such as various pains, voiding and sex-related symptoms. To elucidate the characteristic symptoms of CPPS we compared BPH patients with healthy men. MATERIALS AND METHODS: We obtained questionnaires from 530 men, consisting of three groups: 243 CPPS patients aged 40 or below with small sized prostate ( OR =25ml); and 172 healthy men aged below and equal 40 years without pyuria. We compared various pains and voiding symptoms among the three groups, and the sex-related symptoms between 145 CPPS patients and 64 healthy men who had been married at least 6 months, and had regular sexual intercourse with their wife. RESULTS: In comparison with healthy men, the CPPS patients had a higher prevalence of the various pains and most of the voiding symptoms. The CPPS patients had a higher prevalence of pain over the penis, urethra, perineum and prostate gland compared to the BPH patients (p0.05). CONCLUSIONS: The CPPS patients showed a higher prevalence of various pains and voiding symptoms than the healthy men. Pains over the penis, urethra, perineum and prostate gland are characteristic in CPPS patients. Both the CPPS and BPH patients felt trouble due to the voiding symptoms. The CPPS patients had a higher prevalence of most of sex-related symptoms, but had similar frequencies of sexual intercourse and orgasmic sensation following ejaculation compared to the healthy men.

Change of PSA and PSAD after Antibiotic Treatment in Patients with Prostatitis / 대한남성과학회지

PURPOSE: Serum prostate specific antigen (PSA) is widely used for the early detection of prostate cancer, with biopsies often being performed when the serum concentration exceeds a defined threshold. The concept of prostate specific antigen density (PSAD) was introduced to enhance the specificity of serum PSA for cancer. We investigated the change in serum PSA and PSAD in patients with clinical prostatitis after antibiotic treatment. MATERIALS AND METHODS: A series of 39 patients with chronic prostatitis whose serum PSA and PSAD exceeded 4.0 ng/ml and 0.15 ng/ml/cm3, respectively, were reviewed retrospectively. After they received 4 to 8 weeks of antibiotics, the serum PSA concentration was remeasured. Men with persistently elevated serum PSA concentrations underwent prostate biopsy. RESULTS: The mean pretreatment serum PSA and PSAD was 8.73 ng/ml and 0.24 ng/ml/cm3, respectively. After antibiotic treatment, the mean values decreased significantly, to 4.55 ng/ml and 0.13 ng/ml/cm3, respectively (p<0.05). The mean decrease in serum PSA was 4.19 3.78 ng/ml, a mean relative change 44.3 31.7%. Among 39 men, 22 (56.4%) had their serum PSA and PSAD values return to the normal ranges. Prostate biopsy in 24 patients with persistently elevated serum PSA or PSAD after antibiotic therapy revealed prostate cancer in 4. CONCLUSIONS: Prostatitis is one of the most important factors in serum PSA and PSAD elevation in men without clinically detectable prostate cancer. A decrease in PSA and PSAD after antibiotic treatment can help in avoiding unnecessary prostate biopsies.