What is the Cause of Recurrent Urinary Tract Infection? Contemporary Microscopic Concepts of Pathophysiology / 대한배뇨장애요실금학회지

Urinary tract infections (UTIs) are the most common infectious disease and are mainly caused by Escherichia coli. In this review, we introduce the current concept of recurrent UTI (rUTI) based on recent research dealing with pathophysiology of the disease. Although urine is considered sterile, recent studies dealing with microbiome have proposed different ideas. UTIs have typically been considered as extracellular infections, but recently, uropathogenic Escherichia coli (UPEC) has been shown to bind and replicate in the urothelium to make intracellular bacterial communities. Binding UPECs might proceed in many ways including extracellular expulsion for clearance or survival and quiescent intracellular reservoirs that can cause rUTI. Moreover, it is also suggested that other important factors, such as lipopolysaccharide and multimicrobial infection, can be the cause of rUTI. This review article reveals a key mechanism of recurrence and discusses what makes a pathway of resolution or recurrence in a host after initial infection.

Improvement in Near Vision Following Silodosin Treatment in Patients With Lower Urinary Tract Symptoms / 대한배뇨장애요실금학회지

Purpose@#The objective of this study was to investigate the change in near visual function after the administration of oral silodosin to patients with lower urinary tract symptoms (LUTS). @*Methods@#This prospective study included treatment-naive patients who were scheduled to start treatment with silodosin for LUTS. A comprehensive ophthalmological evaluation including the near vision and the automated pupillometry was performed at baseline and after 3 months of silodosin treatment. For subjective assessment of near visual ability and satisfaction, a Near Activity Visual Questionnaire-10 (NAVQ-10) was also used at the same time (higher scores indicating worse quality). @*Results@#Of 23 patients enrolled in this study, 15 continued with silodosin (8 mg once daily) treatment for 3 months and completed a follow-up evaluation. The mean age of participants was 60.4±8.4 years. Distant visual acuity and spherical error were unchanged after silodosin treatment. However, near vision acuity (logMAR) was improved after treatment (right, 0.47±0.36 vs. 0.38±0.39, P=0.018; left, 0.41±0.37 vs. 0.31±0.34, P=0.068; both, 0.27±0.26 vs. 0.21±0.27, P=0.043). Pupil size under room light decreased significantly in both eyes (right, 3.77±0.60 vs. 3.16±0.58, P=0.001; left, 3.72±0.80 vs. 3.21±0.75, P=0.002). The Rasch scale at NAVQ-10 improved from 54.7±9.9 to 48.5±11.2 (P=0.004). @*Conclusions@#This preliminary study demonstrated that highly selective alpha-1A adrenergic receptor antagonists such as silodosin improve near visual acuity and quality in patients with LUTS/benign prostatic hyperplasia. Decrease in pupil size caused by inhibition of adrenergic alpha 1 mediated contraction of iris dilator muscle is a possible mechanism underlying improved near vision.

Investigation of Information Acquisition Channel for Prostate Cancer High-Risk Group

Purpose@#The survey was conducted on Korean men to examine information acquisition channel for prostate cancer high risk group as part of the “Blue Ribbon Campaign” of the Korean Urological Oncology Society. @*Materials and Methods@#An online survey of 500 men aged 50 years old or older was completed to query investigation of the status of prostate cancer awareness and information acquisition from February 4 to February 9, 2021. @*Results@#Most men in their 50s and older are well aware that prostate cancer can also occur in young men in their 40s, so the rate of misunderstanding of the timing of prostate cancer screening after their 60s is very low. Two-thirds of all respondents (67.2%) were also confirmed that prostate cancer had no initial symptoms and was not included in the national cancer screening. Seventy-five percent of people look up information on their own in case of suspected prostate cancer, and 51.6% seek out knowledge on their own to prevent prostate cancer. Of the respondents, 27.4% of men contacted prostate cancer-related information within the past year, and the percentage of people contacted through ‘Internet/Phone,’ ‘People Around’ and ‘Television’ was high. The most trusted channel among prostate cancer information channels was ‘medical professionals,’ but the experience rate was not high, and the channel with high experience rate and reliability was shown as ‘television.’ @*Conclusions@#Much effort is still needed to understand the information acquisition behavior of Korean men and to improve awareness of early screening for prostate cancer.

What is the Cause of Recurrent Urinary Tract Infection? Contemporary Microscopic Concepts of Pathophysiology / 대한배뇨장애요실금학회지

Urinary tract infections (UTIs) are the most common infectious disease and are mainly caused by Escherichia coli. In this review, we introduce the current concept of recurrent UTI (rUTI) based on recent research dealing with pathophysiology of the disease. Although urine is considered sterile, recent studies dealing with microbiome have proposed different ideas. UTIs have typically been considered as extracellular infections, but recently, uropathogenic Escherichia coli (UPEC) has been shown to bind and replicate in the urothelium to make intracellular bacterial communities. Binding UPECs might proceed in many ways including extracellular expulsion for clearance or survival and quiescent intracellular reservoirs that can cause rUTI. Moreover, it is also suggested that other important factors, such as lipopolysaccharide and multimicrobial infection, can be the cause of rUTI. This review article reveals a key mechanism of recurrence and discusses what makes a pathway of resolution or recurrence in a host after initial infection.

Improvement in Near Vision Following Silodosin Treatment in Patients With Lower Urinary Tract Symptoms / 대한배뇨장애요실금학회지

Purpose@#The objective of this study was to investigate the change in near visual function after the administration of oral silodosin to patients with lower urinary tract symptoms (LUTS). @*Methods@#This prospective study included treatment-naive patients who were scheduled to start treatment with silodosin for LUTS. A comprehensive ophthalmological evaluation including the near vision and the automated pupillometry was performed at baseline and after 3 months of silodosin treatment. For subjective assessment of near visual ability and satisfaction, a Near Activity Visual Questionnaire-10 (NAVQ-10) was also used at the same time (higher scores indicating worse quality). @*Results@#Of 23 patients enrolled in this study, 15 continued with silodosin (8 mg once daily) treatment for 3 months and completed a follow-up evaluation. The mean age of participants was 60.4±8.4 years. Distant visual acuity and spherical error were unchanged after silodosin treatment. However, near vision acuity (logMAR) was improved after treatment (right, 0.47±0.36 vs. 0.38±0.39, P=0.018; left, 0.41±0.37 vs. 0.31±0.34, P=0.068; both, 0.27±0.26 vs. 0.21±0.27, P=0.043). Pupil size under room light decreased significantly in both eyes (right, 3.77±0.60 vs. 3.16±0.58, P=0.001; left, 3.72±0.80 vs. 3.21±0.75, P=0.002). The Rasch scale at NAVQ-10 improved from 54.7±9.9 to 48.5±11.2 (P=0.004). @*Conclusions@#This preliminary study demonstrated that highly selective alpha-1A adrenergic receptor antagonists such as silodosin improve near visual acuity and quality in patients with LUTS/benign prostatic hyperplasia. Decrease in pupil size caused by inhibition of adrenergic alpha 1 mediated contraction of iris dilator muscle is a possible mechanism underlying improved near vision.

Investigation of Information Acquisition Channel for Prostate Cancer High-Risk Group

Purpose@#The survey was conducted on Korean men to examine information acquisition channel for prostate cancer high risk group as part of the “Blue Ribbon Campaign” of the Korean Urological Oncology Society. @*Materials and Methods@#An online survey of 500 men aged 50 years old or older was completed to query investigation of the status of prostate cancer awareness and information acquisition from February 4 to February 9, 2021. @*Results@#Most men in their 50s and older are well aware that prostate cancer can also occur in young men in their 40s, so the rate of misunderstanding of the timing of prostate cancer screening after their 60s is very low. Two-thirds of all respondents (67.2%) were also confirmed that prostate cancer had no initial symptoms and was not included in the national cancer screening. Seventy-five percent of people look up information on their own in case of suspected prostate cancer, and 51.6% seek out knowledge on their own to prevent prostate cancer. Of the respondents, 27.4% of men contacted prostate cancer-related information within the past year, and the percentage of people contacted through ‘Internet/Phone,’ ‘People Around’ and ‘Television’ was high. The most trusted channel among prostate cancer information channels was ‘medical professionals,’ but the experience rate was not high, and the channel with high experience rate and reliability was shown as ‘television.’ @*Conclusions@#Much effort is still needed to understand the information acquisition behavior of Korean men and to improve awareness of early screening for prostate cancer.

Ipsilateral hemichorea after striatal hemorrhage

@#Hemichorea after a striatal lesion of the ipsilateral side of the cerebral hemisphere is a very rare condition. A 72-year-old female presented with right-sided bradykinesia and left-sided hemichorea after a left striatal hemorrhage. In a shape analysis of the brain conducted via MRI, her damaged left basal ganglia was severely contracted whereas her right dorsolateral putamen surface was deformed and hypertrophied. Excessive compensation of the contralateral hemisphere may be a possible mechanism of ipsilateral hemichorea in this case.

Varicocele and Testicular Pain: A Review

Varicocele is the dilatation of the scrotal portion of pampiniform plexus and the internal spermatic venous system. About 15% of men suffer from scrotal varicocele and 2% to 10% of them complain of pain. The probable mechanisms for pain include compression of the surrounding neural fibers by the dilated venous complex, elevated testicular temperature, increased venous pressure, hypoxia, oxidative stress, hormonal imbalances, and the reflux of toxic metabolites of adrenal or renal origin. Testicular pain associated with varicoceles is typically described as a dull, aching, or throbbing pain in the testicle, scrotum, or groin; rarely, it can be acute, sharp, or stabbing. The management of testicular pain associated with varicocele starts with a conservative, non-surgical approach and a period of observation. Varicocelectomy in carefully selected candidates with clinically palpable varicocele resolves nearly 80% of all cases of testicular pain. Microsurgical techniques for varicocelectomy have gained popularity with minimal complication rates and favorable outcomes. The grade of varicocele, the nature and duration of pain, body mass index, prior conservative management, and the type of surgical method used, are predictors for the success of varicocelectomy.

Is It Worth Treating Non-Bothering Nocturia? Results of a Multicenter Prospective Observational Study

PURPOSE: The purpose of this study was to evaluate the efficacy of treatment in patients with non-bothering nocturia. MATERIALS AND METHODS: In this prospective multicenter study, patients who visited hospitals for treatment of voiding symptoms were enrolled. Inclusion criteria were: 1) men >45 years, and 2) nocturia ≥2 confirmed by a three-day voiding diary. Subjects were divided into non-bothering and bothering groups based on International Consultation on Incontinence Questionnaire Nocturia (ICIQ-N) question 2b. Changes in voiding symptoms, frequency of nocturia, and bothersomeness were evaluated with international prostate symptom score (IPSS), ICIQ-N, and three-day voiding diary at 4 and 12 weeks after treatment. RESULTS: A total of 48 patients in the non-bothering nocturia group and 50 patients in the bothering nocturia group who completed the 12-week treatment were analyzed. The total IPSS was decreased by 5.8 in the non-bothering group and 5.2 in the bothering group. There was no significant difference in decrease of IPSS between the two groups. Both groups showed significant reduction in discomfort of nocturia. The ICIQ-N 2b score decreased from 3.9 to 2.7 (p=0.01) in the non-bothering group and from 6.9 to 4.6 (p=0.02) in the bothering group. The number of nocturia episodes was significantly decreased in both groups. CONCLUSIONS: Regardless of discomfort associated with nocturia, both groups showed significant improvement in nocturia-related discomfort and voiding symptoms. These results suggest that patients with nocturia who were unaware of its discomfort benefited from treatment.

A case of intramuscular xanthelasma palpebrarum found during blepharoplasty

Xanthelasma palpebrarum is the most common cutaneous xanthoma found on the medial side of the eyelid. The typical lesion is usually a flat and yellowish plaque on the skin. However, we report on a unique case of intramuscular xanthoma found during blepharoplasty for the correction of ptosis. A 53-year-old male patient visited our department with a complaint of a ptotic eyelid. He was concerned about the cosmetic appearance and the uncomfortable feeling while opening his eyes, and wanted these problems to be solved. A yellowish plaque of about 0.3 × 0.3 cm in size was found in the orbicularis oculi muscle during the surgery. The lesion was excised and xanthelasma was confirmed with biopsy. We have found this specific case of xanthelasma palpebrarum in the only muscle. Therefore, a careful approach to clinical and histologic examination and imaging is required for patients with these lesions.

Nocturia Improvement With Surgical Correction of Sleep Apnea / 대한배뇨장애요실금학회지

PURPOSE: To evaluate changes in nocturia after surgical correction of obstructive sleep apnea (OSA). METHODS: A total of 66 patients were included in the present study. All had been diagnosed with OSA syndrome by polysomnography and underwent uvulopalatopharyngoplasty (UPPP). Preoperative and postoperative lower urinary tract symptoms (LUTS), quality of life (QoL), and nocturia episodes were evaluated using the International Prostate Symptom Score (IPSS) and overactive bladder symptom score (OABSS) questionnaires. Three months postoperatively, telephone interviews were performed to determine the success of surgery, current LUTS, and nocturia episodes. Patients were divided into surgical success and failure groups. Surgical success was defined as snoring decrease more than 50% based on the patient’s subjective judgment. RESULTS: The response rate was 56% and success rate was 73%. In all patients, nocturia episodes significantly decreased from 1.7±1.1 to 0.8±1.2 (P=0.002). Mean IPSS score, OABSS score, and QoL scores were also significantly improved. The success group showed a significant decrease in nocturia episodes, and total IPSS, OABSS, and QoL scores. However, the failure group did not show significant changes in all parameters. CONCLUSIONS: OSA correction improved nocturia as well as other LUTS. These improvements were not observed in the failure group. This study shows that OSA is a cause of nocturia and that other LUTS and nocturia can be improved by surgical correction of OSA.

Prospective Randomized Controlled Study on the Efficacy of Multimedia Informed Consent for Patients Scheduled to Undergo Green-Light High-Performance System Photoselective Vaporization of the Prostate

PURPOSE: The aim of this study was to evaluate the efficacy of a multimedia informed consent (IC) presentation on the understanding and satisfaction of patients who were scheduled to receive 120-W green-light high-performance system photoselective vaporization of the prostate (HPS-PVP). MATERIALS AND METHODS: A multimedia IC (M-IC) presentation for HPS-PVP was developed. Forty men with benign prostatic hyperplasia who were scheduled to undergo HPS-PVP were prospectively randomized to a conventional written IC group (W-IC group, n=20) or the M-IC group (n=20). The allocated IC was obtained by one certified urologist, followed by a 15-question test (maximum score, 15) to evaluate objective understanding, and questionnaires on subjective understanding (range, 0~10) and satisfaction (range, 0~10) using a visual analogue scale. RESULTS: Demographic characteristics, including age and the highest level of education, did not significantly differ between the two groups. No significant differences were found in scores reflecting the objective understanding of HPS-PVP (9.9±2.3 vs. 10.6±2.8, p=0.332) or in subjective understanding scores (7.5±2.1 vs. 8.6±1.7, p=0.122); however, the M-IC group showed higher satisfaction scores than the W-IC group (7.4±1.7 vs. 8.4±1.5, p=0.033). After adjusting for age and educational level, the M-IC group still had significantly higher satisfaction scores. CONCLUSIONS: M-IC did not enhance the objective knowledge of patients regarding this surgical procedure. However, it improved the satisfaction of patients with the IC process itself.

A Rare Case of Diffuse Pachymeningeal Involvement of Multiple Myeloma

Intracranial involvement in multiple myeloma patients takes up around 1%, and is usually known to be present in the parietal bone or skull base in cases of skull vault involvement, while it presents in the dura and parenchyma in cases of intracranial involvement. Primary pachymeningeal invasion is even rarer with extremely rapid progression and very poor prognosis. It is our intent to report a case in which we had to differentiate multiple myeloma with other metastatic tumors, lymphoma, and leukemia with intracranial involvement. Our patient showed an osteolytic lesion of the skull with dural involvement and subdural mass formations.

Discordance between location of positive cores in biopsy and location of positive surgical margin following radical prostatectomy

PURPOSE: We compared location of positive cores in biopsy and location of positive surgical margin (PSM) following radical prostatectomy. MATERIALS AND METHODS: This retrospective analysis included patients who were diagnosed as prostate cancer by standard 12-core transrectal ultrasonography guided prostate biopsy, and who have PSM after radical prostatectomy. After exclusion of number of biopsy cores <12, and lack of biopsy location data, 46 patients with PSM were identified. Locations of PSM in pathologic specimen were reported as 6 difference sites (apex, base and lateral in both sides). Discordance of biopsy result and PSM was defined when no positive cores in biopsy was identified at the location of PSM. RESULTS: Most common location of PSM were right apex (n=21) and left apex (n=15). Multiple PSM was reported in 21 specimens (45.7%). In 32 specimens (69.6%) with PSM, one or more concordant positive biopsy cores were identified, but 14 specimens (28%) had no concordant biopsy cores at PSM location. When discordant rate was separated by locations of PSM, right apex PSM had highest rate of discordant (38%). The discordant group had significantly lower prostate volume and lower number of positive cores in biopsy than concordant group. CONCLUSIONS: This study showed that one fourth of PSM occurred at location where tumor was not detected at biopsy and that apex PSM had highest rate of discordant. Careful dissection to avoid PSM should be performed in every location, including where tumor was not identified in biopsy.

The First Case of Eggerthella lenta Bacteremia in Korea

No abstract available.

The Real Practice of Antibiotic Prophylaxis for Prostate Biopsy in Korea Where the Prevalence of Quinolone-Resistant Escherichia coli Is High

PURPOSE: Transrectal ultrasonography-guided prostate biopsy (TRUS-Bx) is an essential procedure for diagnosing prostate cancer. The American Urological Association (AUA) Guideline recommends fluoroquinolone alone for 1 day during TRUS-Bx. However, this recommendation may not be appropriate in regions where the prevalence of quinolone-resistant Escherichia coli is high. We investigated the real practice of antibiotic prophylaxis for TRUS-Bx in Korea. MATERIALS AND METHODS: A total of 77 hospitals performing TRUS-Bx were identified and an e-mail was sent to the Urology Department of those hospitals. The questions in the e-mail included the choice of antibiotics before and after the procedure and the duration of antibiotic therapy after TRUS-Bx. RESULTS: A total of 54 hospitals (70.0%) responded to the e-mail. Before TRUS-Bx, all hospitals administered intravenous antibiotic prophylaxis. The percentage of hospitals that used quinolone, cephalosporin, and aminoglycoside alone was 48.1%, 20.4%, and 9.3%, respectively. The percentage of hospitals that used two or more antibiotics was 22.2%. After biopsy, all 54 hospitals prescribed oral antibiotics. The percentage of hospitals that prescribed quinolone alone, cephalosporin alone, or a combination of two or more antibiotics was 77.8%, 20.4%, and 1.8%, respectively. The duration of antibiotic use was more than 3 days in most hospitals (79.6%). Only four hospitals (7.4%) followed the AUA recommendation of a 1-day regimen. CONCLUSIONS: The AUA recommendation was not followed by most hospitals in Korea. This clinical behavior might reflect the high quinolone resistance rate in Korea, and further studies on the most efficient prophylactic antibiotics after TRUS-Bx in Korea are warranted.

The Real Practice of Antibiotic Prophylaxis for Prostate Biopsy in Korea Where the Prevalence of Quinolone-Resistant Escherichia coli Is High

PURPOSE: Transrectal ultrasonography-guided prostate biopsy (TRUS-Bx) is an essential procedure for diagnosing prostate cancer. The American Urological Association (AUA) Guideline recommends fluoroquinolone alone for 1 day during TRUS-Bx. However, this recommendation may not be appropriate in regions where the prevalence of quinolone-resistant Escherichia coli is high. We investigated the real practice of antibiotic prophylaxis for TRUS-Bx in Korea. MATERIALS AND METHODS: A total of 77 hospitals performing TRUS-Bx were identified and an e-mail was sent to the Urology Department of those hospitals. The questions in the e-mail included the choice of antibiotics before and after the procedure and the duration of antibiotic therapy after TRUS-Bx. RESULTS: A total of 54 hospitals (70.0%) responded to the e-mail. Before TRUS-Bx, all hospitals administered intravenous antibiotic prophylaxis. The percentage of hospitals that used quinolone, cephalosporin, and aminoglycoside alone was 48.1%, 20.4%, and 9.3%, respectively. The percentage of hospitals that used two or more antibiotics was 22.2%. After biopsy, all 54 hospitals prescribed oral antibiotics. The percentage of hospitals that prescribed quinolone alone, cephalosporin alone, or a combination of two or more antibiotics was 77.8%, 20.4%, and 1.8%, respectively. The duration of antibiotic use was more than 3 days in most hospitals (79.6%). Only four hospitals (7.4%) followed the AUA recommendation of a 1-day regimen. CONCLUSIONS: The AUA recommendation was not followed by most hospitals in Korea. This clinical behavior might reflect the high quinolone resistance rate in Korea, and further studies on the most efficient prophylactic antibiotics after TRUS-Bx in Korea are warranted.

Treatment Outcomes of Helical Intensity-Modulated Radiotherapy for Unresectable Hepatocellular Carcinoma

BACKGROUND/AIMS: This study reports treatment outcomes after helical intensity-modulated radiotherapy (IMRT) in unresectable hepatocellular carcinoma (HCC) patients for whom transarterial chemoembolization (TACE) was considered ineffective or unsuitable. METHODS: From January 2008 to December 2011, 22 unresectable HCC patients received helical IMRT. A daily dose of 1.8 to 4 Gy was delivered at five fractions per week to deliver a total dose of 30 to 60 Gy. The most-prescribed dose fractionation was a total dose of 50 to 57.5 Gy, with a daily dose of 2.3 to 2.5 Gy. RESULTS: In the entire group, the objective response rate of the primary tumor was 72.7%. In the eight patients with portal vein thrombosis (PVT), the objective response rate of PVT was 50.0%. Median disease progression-free survival was 11.8 months, and the 1-year disease progression-free survival rate was 40.2%. The median overall survival was 14.4 months, and the 1- and 2-year overall survival rates were 86.4% and 69.1%, respectively. PVT and Child-Pugh classifications were significant prognostic factors for overall survival in multivariate analyses. CONCLUSIONS: Helical IMRT in patients with unresectable HCC resulted in high treatment response and survival rates. This study suggests helical IMRT is a practical treatment option for HCC patients in whom TACE is unsuitable or ineffective.

Pituitary Stalk Hemangioblastoma in a von Hippel-Lindau Patient : Clinical Course Follow-Up Over a 20-Year Period

Supratentorial hemangioblastomas (HBs) are rare, and pituitary stalk HBs are extremely uncommon; therefore, pituitary stalk evaluation is often overlooked. Herein, we report the development of pituitary stalk HB over a 20-year period and the importance of regular long-term follow up for patients with HBs.

Impact of Prostate Volume on Oncological and Functional Outcomes After Radical Prostatectomy: Robot-Assisted Laparoscopic Versus Open Retropubic

PURPOSE: We compared the impact of prostate volume on oncological and functional outcomes 2 years after robot-assisted laparoscopic prostatectomy (RALP) and open radical retropubic prostatectomy (ORP). MATERIALS AND METHODS: Between 2003 and 2010, 253 consecutive patients who had undergone prostatectomy by a single surgeon were serially followed over 2 years postoperatively. RALP was performed on 77 patients and ORP on 176. The patients were divided into two subgroups according to prostate volume as measured by transrectal ultrasound: less than 40 g and 40 g or larger. Recoveries of potency and continence were checked serially by interview 1, 3, 6, 9, 12, and 24 months postoperatively. RESULTS: RALP was associated with less blood loss (ORP vs. RALP: 910 mL vs. 640 mL, p<0.001) but a longer operation time (150 minutes vs. 220 minutes, p<0.001) than was ORP. No statistically significant differences were found between the two groups for oncological outcomes, such as positive surgical margin (40% vs. 39%, p=0.911) or biochemical recurrence (12% vs. 7%, p=0.155). The overall functional outcomes showed no statistically significant differences at 2 years of follow-up (continence: 97% vs. 94%, p=0.103; potency: 51% vs. 56%, p=0.614). In the results of an inter-subgroup analysis, potency recovery was more rapid in patients who underwent RALP in a small-volume prostate than in those who underwent ORP in a small-volume prostate (3 months: 24% vs. 0%, p=0.005; 6 months: 36% vs. 10%, p=0.024). However, patients who underwent RALP in a large-volume prostate were less likely to recover continence than were patients who underwent ORP in a large-volume prostate (97% vs. 88%, p=0.025). CONCLUSIONS: Patients can be expected to recover erectile function more quickly after RALP than after ORP, especially in cases of a small prostate volume.