Recent Trends in Transurethral Surgeries and Urological Outpatient Procedures: a Nationwide Populationbased Cohort Study

Background@#Demographic change and advances in technology affect transurethral surgery and outpatient procedures in the urologic field. There are few population-based studies that accurately assess the trend of transurethral surgery and outpatient procedures including diagnostic tests. We investigated the recent epidemiologic trends in transurethral surgeries and urological outpatient procedures from 2009 to 2016 in Korea using the entire populationbased cohort. @*Methods@#We analyzed medical service claim data of transurethral surgery, urological outpatient procedures submitted by medical service providers from the Health Insurance Review and Assessment Service from 2009 to 2016. @*Results@#Transurethral ureter surgery increased by 134.9% from 14,635 in 2009 to 34,382 in 2016 (B = 2,698; R 2 = 0.98; P 2 = 0.97; P 2 = 0.04; P = 0.617) and urethral surgery (B = −12; R 2 = 0.18; P = 0.289). The significantly increasing trends in cystoscopy (B = 5,260; R 2 = 0.95; P 2 = 0.99; P 2 = 0.77; P = 0.003) and electrical stimulation treatment (EST: B = −1,034; R 2= 0.87; P < 0.001) significantly decreased. @*Conclusion@#In Korea, transurethral ureter surgery and transurethral bladder surgery have been continuously increasing. Transurethral prostate surgery and transurethral urethral surgery remained constant with no increase or decrease. Cystoscopy and uroflowmetry continue to increase, while UDS and EST continue to decrease.

Effects of reversing the coiling direction on the force-deflection characteristics of nickel-titanium closed-coil springs / 대한치과교정학회지

OBJECTIVE@#To investigate the effects of reversing the coiling direction of nickeltitanium closed-coil springs (NiTi-CCSs) on the force-deflection characteristics.@*METHODS@#The samples consisted of two commercially available conventional NiTi-CCS groups and two reverse-wound NiTi-CCS groups (Ormco-Conventional vs. Ormco-Reverse; GAC-Conventional vs. GAC-Reverse; n = 20 per group). The reverse-wound NiTi-CCSs were directly made from the corresponding conventional NiTi-CCSs by reversing the coiling direction. Tensile tests were performed for each group in a temperature-controlled acrylic chamber (37 ± 1℃). After measuring the force level, the range of the deactivation force plateau (DFP) and the amount of mechanical hysteresis (MH), statistical analyses were performed.@*RESULTS@#The Ormco-Reverse group exhibited a significant shift of the DFP end point toward the origin point (2.3 to 0.6 mm), an increase in the force level (1.2 to 1.3 N) and amount of MH (1.0 to 1.5 N) compared to the Ormco-Conventional group (all p < 0.001), which indicated that force could be constantly maintained until the end of the deactivation curve. In contrast, the GAC-Reverse group exhibited a significant shift of the DFP-end point away from the origin point (0.2 to 3.3 mm), a decrease in the force level (1.1 to 0.9 N) and amount of MH (0.6 to 0.4 N) compared to the GAC-Conventional group (all p < 0.001), which may hinder the maintenance of force until the end of the deactivation curve.@*CONCLUSIONS@#The two commercially available NiTi-CCS groups exhibited different patterns of change in the force-deflection characteristics when the coiling direction was reversed.

Nicotine in High Concentration Causes Contraction of Isolated Strips of Rabbit Corpus Cavernosum

It is well known that cigarette smoke can cause erectile dysfunction by affecting the penile vascular system. However, the exact effects of nicotine on the corpus cavernosum remains poorly understood. Nicotine has been reported to cause relaxation of the corpus cavernosum; it has also been reported to cause both contraction and relaxation. Therefore, high concentrations of nicotine were studied in strips from the rabbit corpus cavernosum to better understand its effects. The proximal penile corpus cavernosal strips from male rabbits weighing approximately 4 kg were used in organ bath studies. Nicotine in high concentrations (10(-5)~10(-4) M) produced dose-dependent contractions of the corpus cavernosal strips. The incubation with 10(-5) M hexamethonium (nicotinic receptor antagonist) significantly inhibited the magnitude of the nicotine associated contractions. The nicotine-induced contractions were not only significantly inhibited by pretreatment with 10(-5) M indomethacin (nonspecific cyclooxygenase inhibitor) and with 10(-6) M NS-398 (selective cyclooxygenase inhibitor), but also with 10(-6) M Y-27632 (Rho kinase inhibitor). Ozagrel (thromboxane A2 synthase inhibitor) and SQ-29548 (highly selective TP receptor antagonist) pretreatments significantly reduced the nicotine-induced contractile amplitude of the strips. High concentrations of nicotine caused contraction of isolated rabbit corpus cavernosal strips. This contraction appeared to be mediated by activation of nicotinic receptors. Rho-kinase and cyclooxygenase pathways, especially cyclooxygenase-2 and thromboxane A2, might play a pivotal role in the mechanism associated with nicotine-induced contraction of the rabbit corpus cavernosum.

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.

Alcohol, Smoking, Physical Activity, Protein, and Lower Urinary Tract Symptoms: Prospective Longitudinal Cohort / 대한배뇨장애요실금학회지

PURPOSE: To evaluate risk factors for deterioration of lower urinary tract symptoms (LUTS) in elderly men in a community-based, prospective longitudinal cohort study. METHODS: In a suburban area in Korea, 1,514 subjects aged > or =45 years were randomly selected by systematic sampling. A total of 918 elderly subjects were enrolled in this in-depth clinical study in 2004. Of these, 547 participants were followed up for 3 years and the data was analyzed in 2014. Standard questionnaires were administered face-to-face by trained interviewers. After excluding women, 224 male participants with complete data including transrectal ultrasonography were included in the final analysis. LUTS were diagnosed using the International Prostate Symptom Score (IPSS) questionnaire. Symptom deterioration was defined as a score of > or =8 points during the 3-year follow-up period. RESULTS: LUTS prevalence increased to 13.1% and the mean IPSS increased by 2.6 points during the 3-year period. After adjusting for confounders, a smoking history of > or =50 pack-years was an independent risk factor for deterioration of LUTS and storage subsymptoms compared with no history of smoking (3.1 and 5.1 odds, respectively). Physical activity had a protective effect on voiding subsymptoms. However, high protein diet and alcohol intake were not associated with LUTS deterioration. CONCLUSIONS: The LUTS prevalence among elderly men living in a suburban area increased to 13.1% and the IPSS increased by 2.6 points during the 3-year period. A history of heavy smoking, low physical activity, and high protein intake were associated with LUTS deterioration. However, there was no significant association between alcohol intake and LUTS deterioration.

Beta-Defensin 124 Is Required for Efficient Innate Immune Responses in Prostate Epithelial RWPE-1 Cells

PURPOSE: The present study aimed to determine the role played by beta-defensin 124 (DEFB124) in the innate immunity of prostate epithelial RWPE-1 cells during bacterial infection. MATERIALS AND METHODS: The expression of DEFB124 was examined by quantitative real-time polymerase chain reaction (PCR), Western blotting, and immunocytochemistry. Enzyme-linked immunosorbent assays and quantitative real-time PCR were performed to determine the production of cytokines and chemokines. Western blotting and chromatin immunoprecipitation studies were performed to assess the interaction between DEFB124 and nuclear factor-kappa B (NF-kappaB) in peptidoglycan (PGN)-stimulated RWPE-1 cells. By chemotaxis assay, we assessed the effect of DEFB124 on the migration of monocytes. RESULTS: Exposure to PGN induced DEFB124 upregulation and NF-kappaB activation through IkappaBalpha phosphorylation and IkappaBalpha degradation. Bay11-7082, an NF-kappaB inhibitor, blocked PGN-induced DEFB124 production. Also, NF-kappaB was shown to be a direct regulator and to directly bind to the -3.14 kb site of the DEFB124 promoter in PGN-treated human prostate epithelial RWPE-1 cells. When DEFB124 was overexpressed in RWPE-1 cells, interestingly, the production of cytokines (interleukin [IL] 6 and IL-12) and chemokines (CCL5, CCL22, and CXCL8) was significantly increased. These DEFB124-upregulated RWPE-1 cells markedly induced chemotactic activity for THP-1 monocytes. CONCLUSIONS: Taken together, these results provide strong evidence for the first time that increased DEFB124 expression via NF-kappaB activation in PGN-exposed RWPE-1 cells enhances the production of cytokines and chemokines, which may contribute to an efficient innate immune defense.

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

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

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

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

The Effect of Tamsulosin and Nifedipine on Expulsion of Ureteral Stones after Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

PURPOSE: We evaluated the effect of tamsulosin and nifedipine on expulsion of ureteral stones after extracorporeal shock wave lithotripsy(ESWL). MATERIALS AND METHODS: We evaluated 96 upper or lower ureteral stone patients. All patients received a single session of ESWL with a piezolith- 3000 and received twice-a-day oral treatment of 5mg trospium chloride. The patients were randomly divided into three groups. Group 1 received once a day oral therapy of 0.2mg tamsulosin. Group 2 received once a day oral therapy of 30mg nifedipine. Group 3 was used as the control group. All patients took oral medication for 2 weeks, and then we analyzed the stone expulsion rate, side effects, and mean numbers of emergency room(ER) visits for pain control. RESULTS: There were no differences in the 3 groups in stone size, location, age, and sex. The total stone expulsion rate was significantly higher in group 1(84.4%) compared with group 3(60.6%)(p=0.032). Patients with lower ureteral stones in group 1 showed a higher expulsion rate(94.1%) than those of group 3(66.7%)(p=0.042). There was no difference in stone expulsion rates between group 2(67.7%) and group 3(60.6%). CONCLUSIONS: These result suggest that adjunctive medical therapy with tamsulosin after an ESWL increased the stone expulsion rate of ureteral stones, especially lower ureteral stones.

Trends in the Emergence of Ciprofloxacin-resistant Escherichia coli and the Relationship with Underlying Diseases in Patients with Urinary Tract Infection / 대한비뇨기과학회지

PURPOSE: The increased use of antibiotics may be the main factor responsible for the development and spread of bacterial resistance. This study demonstrated the relation between quinolone use and the rate of isolating ciprofloxacin-resistant(CIPRO-R) Escherichia coli(E.coli) in patients with urinary tract infection(UTI). MATERIALS AND METHODS: From 2001 to 2006, we determined antimicrobial use for 2,803 in terms of the defined daily dose(DDD) and the antimicrobial use density(AUD), and we surveyed the isolation rates of CIPRO-R E.coli in UTIs in both inpatients and outpatients. We also analyzed the correlation between the number of prescriptions and the resistance rates. RESULTS: Of the 637(22.7%) CIPRO-R E.coli isolates, 297(46.6%) were from inpatients and 340(53.4%) were from outpatients. There was a statistically significant correlation between the rate of isolating CIPRO-R E.coli and the amount of quinolone use for the inpatients(r=0.815, p<0.05) as well as the outpatients(r=0.804, p<0.05). A logistic regression analysis identified previous quinolone use as the independent risk factor(odd ratio: 2.604 [95% confidence interval(CI): 1.639-4.137]) for CIPRO-R E.coli in inpatients. Also, these CIPRO-R E.coli showed low sensitivity to ampicillin and trimethoprim/sufamethoxazole(TMP/SMX) in the inpatients(10.4%, 27.3%) and outpatients(5.1%, 27.1%), respectively. CONCLUSIONS: Our study shows a significant correlation between ciprofloxacin resistance and quinolone use, and previous quinolone use seems to be the risk factor for CIPRO-R E.coli bacteriuria. It is necessary to keep antimictrobial therapy under constant surveillance for the prevention of CIPRO-R E.coli.

Comparative Analysis of the Clinicopathological Characteristics of Patients with Prostate Cancer with a Pathological Gleason Score 3+4 versus Gleason Score 4+3 / 대한비뇨기과학회지

PURPOSE: Gleason score(GS) 7 tumors contain patterns 3 and 4 in various proportions. The clinical and pathological characteristics of patients with GS 3+4 and GS 4+3 found during a radical prostatectomy(RP) were retrospectively evaluated. MATERIALS AND METHODS: 124 cases of GS 7 prostate cancer were identified between April 2004 and February 2006. None of these patients had received either preoperative hormonal therapy, including 5alpha-reductase inhibitors, or radiation therapy. After classifying patients with GS 7 tumors into those with GS 4+3 and GS 3+4 tumors, the two groups were compared according to various clinicopathological parameters. RESULTS: In total, 84(67.7%) and 40(32.3%) of patients had final GS of 3+4 and 4+3, respectively. A final GS of 4+3 was associated with a higher pre-biopsy level of prostate-specific antigen(p<0.001) and a higher biopsy Gleason sum(p<0.001). Also, a higher pathological T stage(p=0.005), tertiary Gleason pattern 5(p<0.001), seminal vesicle invasion(p=0.008), bladder neck invasion(p=0.002), angiolymphatic invasion(p=0.008), perineural invasion(p=0.045), positive surgical margins(p=0.038) and larger tumor volumes(p<0.001) were associated with GS of 4+3. CONCLUSIONS: Our results demonstrated that the statistically significant differences exist between GS 3+4 and 4+3 prostate cancers. Thus, GS 7 prostate cancers may be considered heterogeneous in their biological behaviors, and GS 7 prostate cancers with a GS of 4+3 may be considered more aggressive tumors compared to those with a GS of 3+4.

Efficacy of Radical Retropubic Prostatectomy as the Primary Treatment for Patients with Clinically Localized Prostate Cancer and a Serum PSA Level >or=20ng/ml / 대한비뇨기과학회지

PURPOSE: We retrospectively reviewed the clinicopathological characteristics ofpatients who underwent radical retropubic prostatectomy(RRP), and these patients had clinically localized prostate cancer and a preoperative serum prostate-specific antigen(PSA) level >or=20ng/ml. MATERIALS AND METHODS: Among the 266 patients who underwent RRP without any prior neoadjuvant therapy between March 2004 and March 2006, 29 patients had clinically localized prostate cancer and a preoperative serum PSA level >or=20ng/ml. We analyzed several clinicopathologic factors that might predict organ-confined disease. RESULTS: Of the 29 patients, 11(37.9%) had organ-confined cancer. The level of serum PSA, the PSA density(PSAD), the Gleason score(3+4 or less), the prostate volume, tumor volume and the tumor percentage were significant factors for predicting organ-confined cancer(por=20ng/ml, radical prostatectomy can be considered as the primary treatment for some cases that have a relatively lower PSA and PSAD, a biopsy Gleason score of 3+4 or less and low predictive volume of the tumor from the biopsy results.

Predictive Factor to Regain Erectile Function after Bilateral Nerve Sparing Radical Retropubic Prostatectomy in Korean Men / 대한비뇨기과학회지

PURPOSE: To investigate the significance of various preoperative factors with regard to postoperative erectile function in Korean men undergoing a bilateral nerve sparing radical retropubic prostatectomy (BNSRRP), using the validated Korean version of the International Index of Erectile Function (IIEF-5). MATERIALS AND METHODS: Between March 2004 and March 2005, 83 consecutive patients, who underwent a BNSRRP, with preoperative IIEF-5 scores greater than 13, were retrospectively analyzed. All patients were asked to answer the IIEF-5 questionnaire during the preoperative period and 1 year postoperatively. The responses were stratified on the basis of the clinical characteristics and the preoperative predictive factors for regaining a normal erectile function (NEF: IIEF-5 score> or =18) investigated. RESULTS: At the baseline, 56 patients (67.5%) had NEF. At the 1 year follow-up after the BNSRRP, 58 (70.5%) patients reported a return of a sufficient erection for sexual intercourse, with or without oral phosphodiesterase type 5 (PDE5) inhibitors, but 37 (44.6%) patients regained a NEF. Of these 37 patients, 15 (40.5%) were able to spontaneously regain a NEF, but 22 (59.5%) needed the help of oral PDE5 inhibitors. When the patients were divided according to postoperative NEF and erectile dysfunction (ED: 14< or =IIEF-5 score<18), the preoperative IIEF-5 score was the only significant factor for predicting postoperative NEF after a BNSRRP in univariate (p=0.018) and multivariate analyses [p=0.030, odds ratio: 3.482, 95% confidence interval (CI): 1.125-10.774]. Changes in the IIEF-5 score after a BNSRRP significantly decreased for those with preoperative NEF compared with ED ( 6.1+/-5.24 vs. 9.1+/-7.34, p=0.039). CONCLUSIONS: Our data indicated that preoperative erectile function, as assessed using the IIEF-5 questionnaire, was an independent variable for predicting the recovery of erectile function after a BNSRRP when performed in Korean men.

C-reactive Protein is a Useful Marker to Predict the Severity and Early Response of Acute Pyelonephritis in Women / 대한비뇨기과학회지

PURPOSE: To evaluate the values of C-reactive proteins(CRP) for predicting the severity and results of treatment for acute pyelonephritis in women, we compared the severity of symptoms and signs, the laboratory findings and the initial serum CRP according to the early response to treatment. MATERIALS AND METHODS: We retrospectively analyzed 298 female patients who were diagnosed with acute uncomplicated pyelonephritis between January 2002 and Match 2007. All the medical records were reviewed for a variety of factors, and the baseline characteristics and CRP level were compared between the patients with an early response to treatment and those without according to the 3rd hospital day urine analysis. RESULTS: The initial white blood cell(WBC) counts, the CRP level, the neutrophil ratio and severity of symptoms were significantly higher in the delayed response groups than those in the early response groups. The age, history of previous pyelonephritis, symptom duration, body mass index(BMI), and the number of positive blood and urine cultures were not different between the two groups. According to the results of the multivariate logistic regression analysis, the CRP level, neutrophil ratio and mild symptoms were independent predictive variables that affected the delayed response. The odds ratios(95% CI) were 1.078(1.028-1.131) for the CRP, 1.030(1.001-1.060) for the neutrophil ratio and 9.268(1.072-80.166) for the severe symptoms. The differences between the areas under the ROC curves for CRP and the WBC counts and for the CRP level and neutrophil ratio were statistically significant(p<0.001 and p<0.05, respectively). CONCLUSIONS: We found that the discriminatory power of the initial CRP level was high with regard to predicting an early response. So, we were able to determine a CRP level that would be useful in guiding hospitalization.

The Characteristics of Prostate Cancer with Metabolic Syndrome in Korean Men / 대한비뇨기과학회지

PURPOSE: Metabolic syndrome, a concurrence of disturbed glucose and insulin metabolism, overweight, abdominal fat distribution, dyslipidemia, and hypertension, has been reported to have some association with prostate cancer. Here, we assessed the relationship between metabolic syndrome and prostate cancer. MATERIALS AND METHODS: We assessed a total of 261 men who underwent radical retropubic prostatectomy between January 2004 and May 2005. The patients were stratified into two groups, with metabolic syndrome (n=75) or without (n=186). Metabolic syndrome was defined by the criteria of National Cholesterol Education Program Adult Treatment Panel III. We compared the clinical and pathologic features of specimens between the groups. RESULTS: There was no significant difference between the two groups in terms of mean age, serum prostate specific antigen level, prostate size, Gleason score, and pathologic stage. The tumor volume of prostate cancer was significantly higher in the metabolic syndrome group (6.6+/-5.5cc vs 5.0+/-4.5cc, p=0.010). No significant differences were observed in extracapsular extension, seminal vesicle invasion, bladder neck invasion, angiolymphatic invasion, perineural invasion, and multicentricity of cancer between the two groups. As the component of metabolic syndrome increased, the tumor volume was also found to increase (p-value=0.025). CONCLUSIONS: The data from our study support that metabolic syndrome is closely associated with the development and progression of prostate cancer.

Efficacy of Radical Retropubic Prostatectomy in Patients with Clinically Localized Prostate Cancer and a Biopsy Gleason Score of 8 or Higher / 대한비뇨기과학회지

PURPOSE: We retrospectively reviewed clinicopathological characteristics in patients who underwent radical retropubic prostatectomy (RRP) with clinically localized prostate cancer and a biopsy Gleason score of 8 or higher. MATERIALS AND METHODS: Among 266 patients who underwent RRP without prior any neoadjuvant therapy between March 2004 and March 2006, 29 patients had clinically localized prostate cancer and a biopsy Gleason score of 8 or higher. We analyzed several clinicopathologic factors that predict organ-confined disease, and also investigated the impact on postoperative changes of the biopsy Gleason score. RESULTS: Of 29 patients, 12 (41.4%) had organ-confined cancer. Serum prostate-specific antigen (PSA), prostate-specific antigen density (PSAD), tumor volume, and tumor percentage were significant factors for predicting organ-confined cancer (p<0.05). The number of the positive core, percentage of the positive core, sum of the tumor length of the positive core, tumor percentage of total core length, and tumor percentage of the positive core lngth were also significantly higher in the group with an extraprostatic extension compared to the organ-confined cancer group (p<0.05). Of 29 patients, 14 (48.3%) were downgraded to a Gleason score of 7 or less and had a higher chance (64.3%; p=0.016) of experiencing organ- confined disease than those that remained at Gleason scores of 8-10. CONCLUSIONS: Among patients with clinical localized prostate cancer and a biopsy Gleason score of 8 or higher, radical prostatectomy can be considered for primary treatment in some cases with low PSA and PSAD and low predictive volume of the tumor from biopsy results.

The Relationship of Prostate Volume and the Grade of Prostate Cancer / 대한비뇨기과학회지

PURPOSE: A prostate cancer prevention trial has demonstrated a higher incidence of high-grade prostate cancers(HGPC, Gleason pattern 4 or greater) among men randomized to receive treatment with finasteride. One of the hypotheses was finasteride causes a detection bias with regards to HGPC by reducing the prostate volume. We investigated the relationship between prostate volume and HGPC in prostate biopsy specimens and prostatectomy specimens(RP) from the same patients. MATERIALS AND METHODS: We retrospectively reviewed a cohort of 173 consecutive patients that underwent a radical prostatectomy. We identified risk factors for HGPC on 12 core needle biopsies and then on RP specimens using univariate and multivariate logistic regression analysis. In transrectal ultrasound(TRUS) volume quartiles, the relationship of HGPC and prostate volume was analyzed between the lowest and the highest quartile. RESULTS: By multivariate analysis, risk factors of HGPC were age and prostate-specific antigen(PSA), but TRUS volume was not associated with HGPC in both biopsy and RP specimens. In TRUS volume quartiles, the relationship of HGPC and prostate volume was not significant. In addition, in a comparison of the lowest and the highest quartile, the relationship of HGPC and prostate volume was not significant. CONCLUSIONS: Prostate volume may not be significantly associated with the grade of prostate cancers diagnosed at 12 core(or more) needle biopsies and at a radical prostatectomy.

Priapism Lasting for Over 24 hours Induced by Intracavernous Vasoactive Agents / 대한남성과학회지

PURPOSE: Retrospective study was done to evaluate the causes of priapism lasting for over 24 hours induced by intracavernous vasoactive agents. MATERIALS AND METHODS: Thirteen patients of priapism lasting for 24-60 hours, induced by intracavernous vasoactive drugs, were retrospectively evaluated using medical records or by telephone interviews. Injected vasoactive drugs, providers of the drugs, purpose of the injection, reasons leaving the priapism untreated so long, treatment modalities of the priapism, and change of potency after the treatment were evaluated. RESULTS: Only 2 patients (15.4%) were self-injected to treat erectile dysfunction by doctor's prescription. The others, who received the drugs without doctor's prescription, had injections to enhance their potency (46.1%, n=6) or to treat premature ejaculation (15.4%, n=2). The drugs injected were papaverine (23.1%, n=3), papaverine and phentolamine (23.1%, n=3) or prostaglandin E1(7.7%, n=1), but unknown in 6 (46.1%). The reasons of leaving the priapism untreated were mostly due to lack of no knowledge about the priapism (53.8%, n=7). Aspiration and irrigation with alpha-agonist of corpus cavernosum were applied to all patients. Four patients who did not respond to the treatment underwent shunt operations. All the patients complained of weakened potency after the priapism. CONCLUSIONS: Priapism lasting for over 24 hours induced by intracavernous vasoactive drugs were mostly due to abuse or misuse of the drugs and resulted in weakened potency. To avoid this disaster, the drugs should be given to patients by doctor's prescription with full explanation about the side effects of the drug.

Experimental Study on in Vivo Gene Transfer to Kidney Tumor Using Intrarenal-arterial Administration of Plasmid DNA in Complex with Cationic Polyliposome / 대한비뇨기과학회지

No abstract available.