Effect of Diabetes Mellitus on Symptomatic Improvement After Surgery for Benign Prostatic Hyperplasia in Patients With Lower Urinary Tract Symptom and its Relations With Prostatic Urethral Angulation / 대한배뇨장애요실금학회지

Purpose@#To compare improvement of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia in diabetic versus nondiabetic patients after transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP). @*Methods@#The medical records of 437 patients who underwent TURP or HoLEP at a tertiary referral center from January 2006 to January 2022 were retrospectively analyzed. Among them, 71 patients had type 2 diabetes. Patients in the diabetic mellitus (DM) and non-DM groups were matched 1:1 according to age, baseline International Prostate Symptom Score (IPSS), and ultrasound measured prostate volume. Changes in LUTS were assessed at 3 months after surgery using IPSS and evaluated by categorizing patients according to prostatic urethral angulation (PUA; <50° vs. ≥50°). Medication-free survival after surgery was also investigated. @*Results@#No significant differences were noted between the DM and non-DM groups in baseline characteristics except for comorbidities (i.e., hypertension, cerebrovascular disease, and ischemic heart disease, P=0.021, P=0.002, and P=0.017, respectively) and postvoid residual urine volume (115±98 mL vs. 76±105 mL, P=0.028). Non-DM patients showed significant symptomatic improvement regardless of PUA, while DM patients demonstrated improvement in obstructive symptoms only in those with large PUA (≥51°). Among patients with small PUA, DM patients had worse medication-free survival after surgery compared to controls (P=0.044) and DM was an independent predictor of medication reuse (hazard ratio, 1.422; 95% confidence interval, 1.285–2.373; P=0.038). @*Conclusions@#DM patients experienced symptomatic improvement after surgery only in those with large PUA. Among patients with small PUA, DM patients were more likely to reuse medication after surgery.

The Use of Gonadotropin-Releasing Hormone Agonist Does Not Affect the Development of Cardiovascular Disease in Prostate Cancer Patients: a Nationwide Population-Based Cohort Study

BACKGROUND@#The objective of this study was to investigate whether androgen deprivation therapy (ADT) with gonadotropin-releasing hormone agonist (GnRHa) in prostate cancer (Pca) patients is associated with cardiovascular disease in the cohort based from the entire Korean population.@*METHODS@#Using the Korean National Health Insurance database, we conducted an observational study of 579,377 men who sought treatment for Pca between January 1, 2012 and December 31, 2016. After excluding patients with previously diagnosed cardiovascular disease or who had undergone chemotherapy, we extracted the data from 2,053 patients who started GnRHa (GnRHa users) and 2,654 men who were newly diagnosed with Pca (GnRHa nonusers) between July 1, 2012, and December 31, 2012, with follow-up through December 31, 2016. The primary outcomes were cerebrovascular attack (CVA) and ischemic heart disease (IHD).@*RESULTS@#GnRHa users were older, were more likely to reside in rural areas, had lower socioeconomic status, and had more comorbidities than nonusers (all P < 0.050). Although GnRHa users had an increased incidence of CVA and IHD (P = 0.013 and 0.048, respectively) in univariate analysis, GnRHa use was not associated with the outcomes in multivariate analysis. Furthermore, the cumulative duration of ADT was not associated with the outcomes whereas the associations between age at diagnosis with all diseases were significant.@*CONCLUSION@#Our complete enumeration of the Korean Pca population shows that ADT is not associated with increased risks of cardiovascular disease.

The Use of Gonadotropin-Releasing Hormone Agonist Does Not Affect the Development of Cardiovascular Disease in Prostate Cancer Patients: a Nationwide Population-Based Cohort Study

BACKGROUND@#The objective of this study was to investigate whether androgen deprivation therapy (ADT) with gonadotropin-releasing hormone agonist (GnRHa) in prostate cancer (Pca) patients is associated with cardiovascular disease in the cohort based from the entire Korean population.@*METHODS@#Using the Korean National Health Insurance database, we conducted an observational study of 579,377 men who sought treatment for Pca between January 1, 2012 and December 31, 2016. After excluding patients with previously diagnosed cardiovascular disease or who had undergone chemotherapy, we extracted the data from 2,053 patients who started GnRHa (GnRHa users) and 2,654 men who were newly diagnosed with Pca (GnRHa nonusers) between July 1, 2012, and December 31, 2012, with follow-up through December 31, 2016. The primary outcomes were cerebrovascular attack (CVA) and ischemic heart disease (IHD).@*RESULTS@#GnRHa users were older, were more likely to reside in rural areas, had lower socioeconomic status, and had more comorbidities than nonusers (all P < 0.050). Although GnRHa users had an increased incidence of CVA and IHD (P = 0.013 and 0.048, respectively) in univariate analysis, GnRHa use was not associated with the outcomes in multivariate analysis. Furthermore, the cumulative duration of ADT was not associated with the outcomes whereas the associations between age at diagnosis with all diseases were significant.@*CONCLUSION@#Our complete enumeration of the Korean Pca population shows that ADT is not associated with increased risks of cardiovascular disease.

The Use of Gonadotropin-Releasing Hormone Agonist Does Not Affect the Development of Cardiovascular Disease in Prostate Cancer Patients: a Nationwide Population-Based Cohort Study

Pathological Characteristics of Prostate Cancer in Men Aged < 50 Years Treated with Radical Prostatectomy: a Multi-Centre Study in Korea

BACKGROUND: Recently, younger prostate cancer (PCa) patients have been reported to harbour more favourable disease characteristics after radical prostatectomy (RP) than older men. We analysed young men (< 50 years) with PCa among the Korean population, paying attention to pathological characteristics on RP specimen and biochemical recurrence (BCR). METHODS: The multi-centre, Severance Urological Oncology Group registry was utilized to identify 622 patients with clinically localized or locally advanced PCa, who were treated with RP between 2001 and 2017. Patients were dichotomized into two groups according to age (< 50-year-old [n = 75] and ≥ 50-year-old [n = 547]), and clinicopathological characteristics were analysed. Propensity score matching was used when assessing BCR between the two groups. RESULTS: Although biopsy Gleason score (GS) was lower in younger patients (P = 0.033), distribution of pathologic GS was similar between the two groups (13.3% vs. 13.9% for GS ≥ 8, P = 0.191). There was no significant difference in pathologic T stage between the < 50- and ≥ 50-year-old groups (69.3% vs. 68.0% in T2 and 30.7% vs. 32.0% in ≥ T3, P = 0.203). The positive surgical margin rates were similar between the two groups (20.0% vs. 27.6%, P = 0.178). BCR-free survival rates were also similar (P = 0.644) between the two groups, after propensity matching. CONCLUSION: Contrary to prior reports, younger PCa patients did not have more favourable pathologic features on RP specimen and showed similar BCR rates compared to older men. These findings should be considered when making treatment decisions for young Korean patients with PCa.

The Treatments for Intermediate Risk Prostate Cancer

The population of intermediate-risk prostate cancer patients is a large heterogeneous group with diverse prognoses and challenges the struggle to develop more meticulous and standardized treatment recommendations. Furthermore, there are no specific treatment guidelines based on Korean patients although the cancer nature of this patient group is known to be somewhat different from those of western patients. This review will examine the treatment options for intermediate-risk prostate cancer patients in specific clinical situations. The literature provides evidence that combining androgen deprivation therapy (ADT) for 6 months with radiation therapy (RT) may have superior survival than RT alone. Also, patients with adverse pathologic features and lymph node metastasis will benefit from adjuvant RT and ADT respectively after radical prostatectomy (RP). In addition, patients with life expectancy ≥10 years will benefit from lymphadenectomy during RP when lymph node metastasis is suspected as well as neurovascular bundle saving during RP is recommended because of its superior functional results.

Comparative analysis of oncologic outcomes for open vs. robot-assisted radical prostatectomy in high-risk prostate cancer

PURPOSE: To evaluate the oncologic outcomes of robot-assisted radical prostatectomy (RARP) in high-risk prostate cancer (PCa), we compared the surgical margin status and biochemical recurrence-free survival (BCRFS) rates between retropubic radical prostatectomy (RRP) and RARP. MATERIALS AND METHODS: A comparative analysis was conducted of high-risk PCa patients who underwent RRP or RARP by a single surgeon from 2007 to 2013. High-risk PCa was defined as clinical stage> or =T3a, biopsy Gleason score 8-10, or prostate-specific antigen>20 ng/mL. Propensity score matching was performed to minimize selection bias, and all possible preoperative and postoperative confounders were matched. A Kaplan-Meier analysis was performed to assess the 5-year BCRFS, and Cox regression models were used to evaluate the effect of the surgical approach on biochemical recurrence. RESULTS: A total of 356 high-risk PCa patients (106 [29.8%] RRP and 250 [70.2%] RARP) were included in the final cohort analyzed. Before adjustment, the mean percentage of positive cores on biopsy and pathologic stage were poorer for RRP versus RARP (p=0.036 vs. p=0.054, respectively). The unadjusted 5-year BCRFS rates were better for RARP than for RRP (RRP vs. RARP: 48.1% vs. 64.4%, p=0.021). After adjustment for preoperative variables, the 5-year BCRFS rates were similar between RRP and RARP patients (48.5% vs. 59.6%, p=0.131). The surgical approach did not predict biochemical recurrence in multivariate analysis. CONCLUSIONS: Five-year BCRFS rates of RARP are comparable to RRP in high-risk PCa. RARP is a feasible treatment option for high-risk PCa.

Multimodal Treatments of Cystine Stones: An Observational, Retrospective Single-Center Analysis of 14 Cases

PURPOSE: To document the experiences of a single institution in evaluating the clinical courses and treatment outcomes of patients with cystine stones. MATERIALS AND METHODS: The clinical data of 14 patients with cystine stones who were treated at our institution from March 1994 to July 2012 were reviewed. These data included age at first visit, gender, family history, body mass index, presence of a single kidney, stone locations, stone burden, routine urinalysis, and culture. In addition, we also analyzed data on surgery, shock wave lithotripsy, medical treatment, stone recurrence or regrowth, and overall treatment success rates. RESULTS: The mean age of our patients at their first visit was 19.6+/-5.0 years, and eight patients were males. The median stone burden and mean urine pH before each surgery were 6.5 cm2 and 6.5+/-0.9, respectively. Two patients had a family history of cystine stones. Patients underwent surgery an average of 2.7 times. The median interval between surgeries was 27.3 months, and 1 open surgery, 12 percutaneous nephrolithotomies, and 25 ureterorenoscopies were performed. Potassium citrate or sodium bicarbonate was used in nine cases. D-Penicillamine was continuously used in three patients. Patients had an average incidence of 3.2 recurrences or regrowth of stones during the median follow-up period of 60.5 months. CONCLUSIONS: Patients with cystine stones have high recurrence or regrowth rates and relatively large stone burdens. Adequate treatment schedules must therefore be established in these cases to prevent possible deterioration of renal function.

Changes in Serum Prostate-Specific Antigen Levels after Potassium-Titanyl-Phosphate (KTP) Laser Vaporization of the Prostate

PURPOSE: The prostate-specific antigen (PSA) level decreases after transurethral resection of the prostate (TURP). However, changes in the PSA level after potassium-titanyl-phosphate (KTP) laser vaporization of the prostate are not well known. The aim of this study was to investigate the effect of KTP laser vaporization of the prostate on PSA levels in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Serum PSA levels were checked before and 1, 3, 6, and 12 months after the procedure in patients who underwent KTP laser vaporization between October 2004 and August 2008. Patients with prostate cancer, a history of urinary retention, or prostatitis during the follow-up period were excluded. The results for 278 patients were studied. RESULTS: The mean age of the patients was 69.0+/-6.7 years (range, 50-91 years) and the mean preoperative PSA level was 2.72+/-2.93 ng/ml. The PSA level tended to be increased at 1 month after the operation (3.18+/-3.23 ng/ml, p=0.032) but decreased within 3 months and became stabilized after 6 months at 1.79+/-1.82 ng/ml (p<0.001). CONCLUSIONS: PSA levels may increase after KTP laser vaporization for a certain period of time, but eventually decrease and become stabilized after 6 months. Therefore, it may be appropriate to wait up to 3 months if the PSA level rises after the procedure, and further investigation should be considered if the PSA level still remains high after 6 months.

The Preoperative Factors Predicting a Positive Frozen Section during Radical Prostatectomy for Prostate Cancer

PURPOSE: The purpose of this study was to identify the preoperative factors that predict a positive frozen section during radical prostatectomy for prostate cancer. MATERIALS AND METHODS: We retrospectively analyzed preoperative prostate-specific antigen (PSA), prostate volume, Gleason score, the number or percent (%) of cancer-positive cores from prostate biopsy, and the clinical stage of 364 patients who underwent radical prostatectomy between 1993 and 2007. We compared these parameters between patients who had positive frozen sections in specimens from the urethra or bladder neck with those who had negative frozen sections. RESULTS: The PSA and Gleason score were significantly higher and prostate volume was significantly smaller in patients with positive frozen sections in the urethra than in patients with negative frozen sections. The results were the same for the bladder neck. In multivariate analysis, PSA was the only independent predictor for positive frozen sections at the bladder neck, and the cutoff value was 8.71 ng/ml. CONCLUSIONS: Preoperative PSA may be a potent factor for predicting positive frozen sections during radical prostatectomy, especially in the bladder neck. Therefore, it may be beneficial to prepare frozen sections of the bladder neck during the operation to reduce the positive resection margin when PSA is higher than 8.7 ng/ml.

Percutaneous Nephrolithotomy: A Single Center Experience of 610 Cases

PURPOSE: We performed this study to evaluate the outcomes and complications of percutaneous nephrolithotomy (PCNL) at a single institute with a large series. MATERIALS AND METHODS: We reviewed the medical records of 610 patients who underwent PCNL between March 1995 and June 2008 for staghorn calculi in 139 (22.8%), partial staghorn calculi in 104 (17.0%), renal pelvis stone in 222 (36.4%), proximal ureter calculi in 60 (9.8%), and calculi within a caliceal diverticulum in 85 (13.9%) patients. Stone-free status was defined as no visible residual calcification or remnant calcification smaller than 4 mm in diameter (clinically insignificant residual fragment) on a plain KUB (X-ray examination of the kidney, ureter, and bladder) image. Characteristics of the stones, operation time, stone-free rate, and complications were evaluated. RESULTS: Initial stone burden was 665.9+/-600.6 mm2. Average operation time was 103.2+/-58.6 minutes. The mean hospital stay was 7.9 days. The stone-free rate was 84.9%, and ancillary procedures were required in 66 patients (10.8%), including 34 (5.6%) second-look PCNL and 26 (4.3%) ureteroscopic procedures. In the univariate analysis for prediction of stone-free rate, hydronephrosis, stone type, stone composition, and stone burden were significant prognostic factors. In the multivariate analysis, initial stone burden was the only independent factor affecting the stone-free rate. Complications were found in 95 patients (16.1%), 5 (0.8%) of whom needed embolization due to bleeding and 23 (3.8%) of whom showed pleural complications. CONCLUSIONS: PCNL is an effective method for the treatment of staghorn, large calyceal, and some upper ureteral stones with acceptable complication rates.

Transperitoneal Laparoscopic Upper Pole Heminephrectomy in Pediatric Patients with Duplex Kidneys: Comparison with an Age-Matched Cohort of Open Surgery

PURPOSE: We evaluated the safety and feasibility of transperitoneal laparoscopic upper pole heminephrectomy (TLUHN) in pediatric patients by comparing an age-matched cohort undergoing open upper pole heminephrectomy (OUHN) by a single surgeon. MATERIALS AND METHODS: A total of 10 OUHNs were performed between 1995 and 2003 and 10 TLUHNs between 2003 and 2008. The 10 patients in each group were matched by age (p=0.94), gender (p=1.0), and body weight (p=0.91). RESULTS: There was no open conversion in the TLUHN group. The median operative time in the TLUHN and OUHN groups was 174 minutes (range, 98-205) and 190 minutes (range, 120-258), respectively (p=0.19). In the TLUHN and OUHN groups, the median blood loss was 25 ml (range, 20-30) and 35 ml (range, 20-100) (p=0.74), the median analgesic requirement was 0 hours (range, 0-42) and 0 hours (range, 0-87) (p=0.16), and the median hospital stay was 5.5 days (range, 3-7) and 7 days (range, 3-19) (p=0.01), respectively. There were no intraoperative complications in either group. Postoperative atelectasis occurred in two and five patients in the TLUHN and OUHN groups, respectively. Similar results were found in the subanalysis of patients younger than 24 months. CONCLUSIONS: TLUHN is safe and feasible even in small children and infants. Furthermore, decreased hospital stay is the main advantage of the laparoscopic approach compared with open surgery.