Clinical significance of serum neutrophil gelatinase-associated lipocalin in the early diagnosis of renal function deterioration after radical nephrectomy / 고신대학교의과대학학술지

OBJECTIVES: The standard metrics used to monitor the progression of acute kidney injury (AKI) include markers such as serum creatinine, blood urea nitrogen, and estimated glomerular filtration rate (eGFR). Moreover, neutrophil gelatinase-associated lipocalin (NGAL) expression has been reported to modulate oxidative stress. METHODS: We aimed to evaluate the usefulness of serum NGAL levels for monitoring renal function after radical nephrectomy (RN). We prospectively collected data from 30 patients who underwent RN. We analyzed serum NGAL and creatinine at 6 time points: preoperative day 1, right after surgery, 6 hours after surgery, postoperative day (POD) 1, POD 3, and POD 5. We compared these measurements according to the eGFR values (classified as chronic kidney disease stage III; CKD III or not) using data obtained 3 months after surgery. RESULTS: The mean age was 65.5 years (range, 45–77 years), and the male-to-female ratio was 2:1. At the last follow-up examination, there were 12 patients (40%) with CKD III. Using receiver operating characteristic analysis, we found that serum creatinine on POD 5 (area under the curve [AUC], 0.887; P= 0.000) and NGAL at 6 hours after LRN (AUC, 0.743, P= 0.026) were significant predictors of CKD III. The development of CKD III after LRN was associated with the serum creatinine level on POD 5 and the NGAL at 6 hours after surgery. CONCLUSIONS: Compared to serum creatinine, serum NGAL enabled earlier prediction of postoperative CKD III. Therefore, serum NGAL measured 6 hours after surgery could be a useful marker for managing patients after RN.

Primary Androgen Deprivation Therapy for Prostate Cancer in Koreans: A Retrospective Multicenter Study

PURPOSE: To evaluate the characteristics of patients who received primary androgen deprivation therapy (PADT) for prostate cancer and the clinical efficacy of this treatment. MATERIALS AND METHODS: Two hundred forty patients treated by PADT were reviewed. These patients could not receive definitive therapy owing to old age, patient need, and medical comorbidity. The patients were divided into three groups according to the extent of prostate cancer: localized, locally advanced, and metastatic. Then, prostate-specific antigen (PSA) progression in these groups was analyzed. RESULTS: The median age of the patients was 73.0 years, and the median pretreatment PSA level was 47.0 ng/mL. Of the patients, 91.7% were treated with combined androgen blockade, and 8.3% were treated with monotherapy. Clinical factors for PSA progression were a PSA nadir and a high clinical stage. Estimated PSA recurrence-free median survival time in each group was 57, 24, and 12 months, respectively. A PSA nadir of >0.2 ng/mL and metastatic stage were independent factors for expecting a poor response to PADT (hazard ratio 4.26, p<0.001; and 2.60, p<0.001). CONCLUSIONS: Patients with localized or locally advanced prostate cancer who did not receive definitive therapy had lower PSA progression rates than those at metastatic stage during PADT. Further, a PSA nadir of < or =0.2 ng/mL showed better progression-free survival. Therefore, PADT can be another therapeutic option in well-selected patients with localized or locally advanced prostate cancer and PSA change should be checked carefully.

Cancer of the Prostate Risk Assessment (CAPRA) Preoperative Score Versus Postoperative Score (CAPRA-S): Ability to Predict Cancer Progression and Decision-Making Regarding Adjuvant Therapy after Radical Prostatectomy

The University of California, San Francisco, announced in 2011 Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score which included pathologic data, but there were no results for comparing preoperative predictors with the CAPRA-S score. We evaluated the validation of the CAPRA-S score in our institution and compare the result with the preoperative progression predictor, CAPRA score. Data of 130 patients were reviewed who underwent radical prostatectomy for localized prostate cancer from 2008 to 2013. Performance of CAPRA-S score in predicting progression free probabilities was assessed through Kaplan Meier analysis and Cox proportional hazards regression test. Additionally, prediction probability was compared with preoperative CAPRA score by logistic regression analysis. Comparing CAPRA score, the CAPRA-S score showed improved prediction ability for 5 yr progression free survival (concordance index 0.80, P = 0.04). After risk group stratification, 3 group model of CAPRA-S was superior than 3 group model of CAPRA for 3-yr progression free survival and 5-yr progression free survival (concordance index 0.74 vs. 0.70, 0.77 vs. 0.71, P < 0.001). Finally the CAPRA-S score was the more ideal predictor concerned with adjuvant therapy than the CAPRA score through decision curve analysis. The CPARA-S score is a useful predictor for disease progression after radical prostatectomy.

Cancer of the Prostate Risk Assessment (CAPRA) Preoperative Score Versus Postoperative Score (CAPRA-S): Ability to Predict Cancer Progression and Decision-Making Regarding Adjuvant Therapy after Radical Prostatectomy

The University of California, San Francisco, announced in 2011 Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score which included pathologic data, but there were no results for comparing preoperative predictors with the CAPRA-S score. We evaluated the validation of the CAPRA-S score in our institution and compare the result with the preoperative progression predictor, CAPRA score. Data of 130 patients were reviewed who underwent radical prostatectomy for localized prostate cancer from 2008 to 2013. Performance of CAPRA-S score in predicting progression free probabilities was assessed through Kaplan Meier analysis and Cox proportional hazards regression test. Additionally, prediction probability was compared with preoperative CAPRA score by logistic regression analysis. Comparing CAPRA score, the CAPRA-S score showed improved prediction ability for 5 yr progression free survival (concordance index 0.80, P = 0.04). After risk group stratification, 3 group model of CAPRA-S was superior than 3 group model of CAPRA for 3-yr progression free survival and 5-yr progression free survival (concordance index 0.74 vs. 0.70, 0.77 vs. 0.71, P < 0.001). Finally the CAPRA-S score was the more ideal predictor concerned with adjuvant therapy than the CAPRA score through decision curve analysis. The CPARA-S score is a useful predictor for disease progression after radical prostatectomy.

Predictive Value of the Cancer of the Prostate Risk Assessment Score for Recurrence-Free Survival After Radical Prostatectomy in Korea: A Single-Surgeon Series

PURPOSE: To evaluate the validity of the cancer of the prostate risk assessment (CAPRA) score, a newly developed nomogram for preoperative prediction of recurrence after radical prostatectomy, in a single institution in Korea. MATERIALS AND METHODS: We retrospectively studied 115 men who had undergone radical prostatectomy as the first treatment for localized prostate cancer. The validity of the CAPRA score for the prediction of recurrence-free survival (RFS) and pathologic outcome was evaluated by using Kaplan-Meier analysis and a proportional hazards regression model. A seven-group model and a three-group model were used for the results. RESULTS: None of the variables of the CAPRA score was favorable compared with the previously reported data. The three-group model was significantly related with 3- and 5-year RFS (p<0.05), but the seven-group model was not. The concordance indices of the CAPRA score were 0.74 and 0.77. Of four components excluding the clinical T stage, three independently predicted RFS (age, Gleason sum, and percentage of positive biopsies). The CAPRA score was significantly related to the margin status, extracapsular extension, and seminal vesicle invasion in both the seven- and three-group models. In the three-group model, pathologic outcomes were more strongly related, especially a higher risk of seminal vesicle invasion. CONCLUSIONS: The CAPRA score showed high accuracy for predicting RFS. In particular, the three-group model was more useful for predicting RFS and pathologic outcomes. Therefore, the CAPRA score may be a useful prediction model for risk stratification and may help clinicians to develop localized prostate cancer treatment.

Simultaneous Occurrence of Chromophobe Renal Cell Carcinoma and Urothelial Carcinoma in the Same Kidney

The simultaneous occurrence of a renal cell carcinoma and a urothelial carcinoma in the same kidney is uncommon. Here we report the case of a 79-year-old woman with ipsilateral synchronous renal cell carcinoma and urothelial carcinoma. She was referred to our hospital for gross hematuria and right flank pain. A computed tomography scan showed a 15x20 mm enhanced lesion on the upper calyx and a 12x15 mm mass on the lateral aspect of the right kidney. We thus suspected a renal pelvis tumor and performed right hand assisted laparoscopic nephroureterectomy with bladder cuff excision (HALSNU). Gross findings were multiple, pale yellowish papillary masses on the upper and lower major calices, of which the largest one measured 16x20 mm. A separated solid mass measuring 12x16 mm was also noted on the anterior midportion of the kidney. The former was a urothelial carcinoma and the latter was a chromophobe renal cell carcinoma. We present a rare case of a chromophobe renal cell carcinoma and a urothelial carcinoma in the same kidney.

Effectiveness of Transurethral Coagulation and Incision of Ejaculatory Duct for Hematospermia Caused by Ejaculatory Duct Cyst and Obstruction

PURPOSE: To evaluate the usefulness and effectiveness of transurethral coagulation and incision of the ejaculatory duct for hematospermia caused by ejaculatory duct cyst and obstruction. MATERIALS AND METHODS: Twenty-six patients with hematospermia were enrolled. Ejaculatory duct cyst or obstruction was diagnosed by transrectal ultrasound or MRI, revealing seminal vesicle hypertrophy and cystic dilated ejaculatory ducts. One patient had hematospermia associated with infertility. The mean age of the patients and their duration of symptoms were 42.7 years (range, 25-67 years) and 16 months (range, 1-60 months), respectively. All patients underwent transurethral management for treatment of their ejaculatory duct obstruction in the form of incision and coagulation of the ejaculatory duct. We used a 9.5 Fr rigid ureteroscope (Stortz(R), Germany) and a Bugbee electrode. Patients were followed for more than 3 months after the procedure. RESULTS: All patients reported improvement of hematospermia and disappearance of midline cysts, except for one patient. The one case, ureteroscope failed to pass through verumontanum. A ejaculatory duct cyst was found in 18 cases. Calculi were present in the seminal vesicle and ejaculatory ducts in 7 patients and were removed with endoscopic instruments. One infertile patient regained reproductive ability after the procedure. Postoperative complications, such as epididymitis, orchitis, or retrograde ejaculation were not observed. CONCLUSIONS: Transurethral incision and coagulation was a safe and effective treatment option for hematospermia caused by ejaculatory duct obstruction and is considered to be a successful treatment option for infertility secondary to ejaculatory duct obstruction.

A Survey of Understanding of Viagra in primary Physician and General Population / 대한남성과학회지

PURPOSE: Sildenafil citrate(Viagra(R)), a PDE-5 inhibitor in the corpus carvenosum to facilitate penile erection has improved impaired erectile responses in men and has been accepted as a primary treatment of erectile dysfunction. However, complications occurred by Viagra have increased due to its overuse and misuse. Therefore, we have performed a survey to compare physicians and general population in Busan, Korea to assess their understanding of Viagra. Methods and Materials: In 2007, printed surveys were mailed to randomly sampled candidates of 197 primary physicians and 696 individuals from general population, 327 medical students in Busan were surveyed by door-to-door visits. We assessed opinions associated with Viagra eliciting their understanding about its safety, direction, and complications. Data were analyzed using SPSS and were identified by crosstabulation analysis using Ki-square test. RESULTS: Of 1,265 eligible responses, several differences were found between the 3 groups. Compared to general population, the others were more likely to understand the efficacy, directions, and complications of Viagra. Physicians and medical students(43.1% and 39.0%) gave more preference than general population(26.1%) to using Viagra. There were differences in understanding of Viagra with changes of education level. However, it showed no significant differences about idea of illegal Viagra and combination usage with nitrates. Conclusion: The number of patients using Viagra is increasing but their understanding about Viagra is still poor. Moreover, general populations understand Viagra as 'assistant' for erection poorly. Even some medical students understand more than physicians. The ideas of complications would likely affect to negative thinking about usage for Viagra. Therefore more active and continuous educations for proper use of Viagra are suggested for medical efficacy and less complications.

Renal Intracystic Massive Hemorrhage after Blunt Trauma / 대한비뇨기과학회지

Spontaneous and post-traumatic renal intracystic hemorrhages are extremely rare, but are a potential danger to patients with cystic kidney disease. We report two cases of post-traumatic intracystic massive hemorrhage in renal cysts. One patient was a 27-year-old male who presented with left flank pain and gross hematuria after slipping on the stairs 2 days previously. The other patient was a 58-year-old male who presented with back pain due to an accident. The circulatory states of the two patients were deteriorated and renal intracystic hemorrhages were detected on computed tomography. One patient underwent a simple nephrectomy and the other patient was treated with arterial embolization. We present two cases of renal intracystic hemorrhage, emphasizing early diagnosis and the treatment of choice.