Cross-Sectional Association of Metabolic Syndrome and Its Components with Serum Testosterone Levels in a Korean-Screened Population

A Review of Three-Dimensional Printing Technology for Medical Applications

Three-dimensional (3D) printing technology, with additive manufacturing, can aid in the production of various kinds of patient-specific medical devices and implants in medical fields, which cannot be covered by mass production systems for producing conventional devices/implants. The simulator-based medical image demonstrates the anatomical structure of the disease, which can be used for education, diagnosis, preparation of treatment plan and preoperative surgical guide, etc. The surgical guide is used as a patient-specific medical device for guiding incision, resection, insertion, and marking. As 3D printers can output materials that can be inserted into the human body, the patient-specific implant device that reflects the patient's anatomy and surgical plan could be of relevance. In addition, patient-specific aids, including gibs, splints, prostheses, and epitheses, could be used for a better outcome. Finally, bio-printing is also used to cultivate cells to produce functional artificial tissues.

Comparison of Prognosis in Types 1 and 2 Papillary Renal Cell Carcinoma and Clear Cell Renal Cell Carcinoma in T1 Stage

PURPOSE: We compared subtypes of papillary renal cell carcinoma (pRCC; types 1 and 2) and clear cell renal cell carcinoma (ccRCC) in patients with T1-stage RCC to analyze the impact of the subtype on oncological outcomes. MATERIALS AND METHODS: This paper reviewed 75 patients with pRCC and 252 patients with ccRCC at T1-stage from 1998–2012. Thus, we assessed the impact of subtype on oncologic outcomes among patients with T1-stage RCC. We used Kaplan-Meier analysis to estimate the overall survival and recurrence-free survival The median follow-up duration was 95 months (interquartile range, 75.4–119.3 months). RESULTS: The 5-year recurrence-free survivals of pRCC and ccRCC were 95.4% and 97.6%, respectively. pRCC is worse than ccRCC in terms of recurrence-free survival (p=0.008) and there was no significant difference in the overall survival between pRCC and ccRCC (p=0.32). In addition, there was no significant statistical difference between type 1 pRCC and type 2 pRCC in terms of either recurrence-free survival (p=0.526) or overall survival (p=0.701). Age (hazard ratio [HR], 1.069; p < 0.001) and recurrence (HR, 4.93; p < 0.001) were predictors of overall survival. Only tumor size (HR, 1.071; p=0.004) was predictors in the case of cancer specific survival in the multivariate analysis. CONCLUSIONS: Among patients with T1-stage RCC, recurrence after surgery was more common in pRCC than ccRCC. The subtype of pRCC (types 1 and 2) had no impact on the recurrence-free survival or overall survival.

Impact of Histologic Variants of Bladder Cancer on Oncology Outcome After Radical Cystectomy

PURPOSE: To evaluate the oncological outcome of histologic variants in bladder cancer patients who underwent radical cystectomy. MATERIALS AND METHODS: We identified 393 bladder cancer patients who underwent radical cystectomy at single center between January 2007 and August 2014. Patients were divided into 4 groups according to histologic types: pure urothelial cell carcinoma (UC) and squamous, micropapillary, and other variants. Kaplan-Meier analysis was performed to assess recurrence-free (RFS) and overall survivals (OS). The patients were divided into those with pathologic stage and nodal status. RESULTS: Among 393 bladder cancer patients, squamous, micropapillary histologic variants were observed in 38 (9.7%), 26 (6.6%), respectively, whereas 39 had other variant types. Stage T3 cancer occurred in more patients with histologic variant compared with those with pure UC. Pathologic positive nodal status was also frequently found in the histologic variant groups. Subgroup analysis according to T stage and nodal status showed no significant difference in RFS and OS. On multivariate analysis, pathologic T stage (stage T2: hazard ratio [HR], 2.75; 95% confidence interval [CI], 1.34–5.63; p=0.005; stage ≥T3: HR, 3.20; 95% CI, 1.62–6.30; p=0.001) and nodal status (HR, 1.85; 95% CI, 1.05–2.56; p=0.028) were prognostic factors for RFS. CONCLUSIONS: In patients who underwent radical cystectomy, histologic variants were detected more often at advanced pathologic stage. Although histologic variants have been identified in the radical cystectomy specimen, treatment should be performed according to the pathologic stage.

Three-Dimensional Printing: Basic Principles and Applications in Medicine and Radiology

The advent of three-dimensional printing (3DP) technology has enabled the creation of a tangible and complex 3D object that goes beyond a simple 3D-shaded visualization on a flat monitor. Since the early 2000s, 3DP machines have been used only in hard tissue applications. Recently developed multi-materials for 3DP have been used extensively for a variety of medical applications, such as personalized surgical planning and guidance, customized implants, biomedical research, and preclinical education. In this review article, we discuss the 3D reconstruction process, touching on medical imaging, and various 3DP systems applicable to medicine. In addition, the 3DP medical applications using multi-materials are introduced, as well as our recent results.

The Type of Nephrectomy Has Little Effect on Overall Survival or Cardiac Events in Patients of 70 Years and Older With Localized Clinical T1 Stage Renal Masses

PURPOSE: To compare the outcomes of nephron-sparing options (e.g., partial nephrectomy [PN]) and low-surgical-morbidity options (e.g., radical nephrectomy [RN]) in elderly patients with limited life expectancy. MATERIALS AND METHODS: We retrospectively reviewed 135 patients aged 70 years or older who underwent RN (n=82) or PN (n=53) for clinical T1 stage renal masses between January 2000 and December 2012. Clinicopathologic data were thoroughly analyzed and compared between the RN and PN groups. The modification of diet in renal disease equation was used to estimate glomerular filtration. Overall survival and cardiac events were assessed by using Kaplan-Meier survival analysis and Cox proportional-hazards regression modeling. RESULTS: Over a median follow-up period of 59.72 months, 17 patients (20.7%) in the RN group and 3 patients (5.7%) in the PN group died. Chronic kidney disease (<60 mL/min/1.73 m2) developed more frequently in RN patients than in PN patients (75.6% vs. 41.5%, p<0.001). The 5-year overall survival rate did not differ significantly between the RN and PN groups (90.7% vs. 93.8%; p=0.158). According to the multivariate analysis, the Charlson comorbidity index score was an independent predictor of overall survival (hazard ratio [HR], 2.679, p=0.037). Type of nephrectomy was not significantly associated with overall survival (HR, 2.447; p=0.167) or cardiac events (HR, 1.147; p=0.718). CONCLUSIONS: Although chronic kidney disease was lower after PN, overall survival and cardiac events were similar regardless of type of nephrectomy.

Retropubic Versus Robot-Assisted Laparoscopic Prostatectomy for Prostate Cancer: A Comparative Study of Postoperative Complications

PURPOSE: To compare the complications of radical retropubic prostatectomy (RRP) with those of robot-assisted laparoscopic prostatectomy (RALP) performed by a single surgeon for the treatment of prostate cancer. MATERIALS AND METHODS: The postoperative complications of 341 patients who underwent RRP and 524 patients who underwent RALP for prostate cancer at the Asan Medical Center between July 2007 and August 2012 were retrospectively reviewed and compared. Complications were classified according to the modified Clavien classification system. RESULTS: RALP was associated with a shorter length of hospital stay (mean, 7.9 days vs. 10.1 days, p<0.001) and duration of urethral catheterization (6.2 days vs. 7.5 days, p<0.001) than RRP. Major complications (Clavien grade III-IV) were less common in the RALP group than in the RRP group (3.4% vs. 7.6%, p=0.006). There were no significant differences in medical complications between procedures. Considering surgical complications, urinary retention (7.0% vs. 2.7%, p=0.002) and wound repair (4.1% vs. 0.2%, p<0.001) were more common after RRP than after RALP. Extravasation of contrast medium during cystography was more common in the RRP group than in the RALP group (10.0% vs. 2.1%, p<0.001). CONCLUSIONS: RALP is associated with a lower complication rate than RRP.

Clinical Experience with Limited Lymph Node Dissection for Prostate Cancer in Korea: Single Center Comparison of 247 Open and 354 Robot-Assisted Laparoscopic Radical Prostatectomy Series

PURPOSE: There are limited data on the role of limited pelvic lymph node dissection (PLND) in patients with prostate cancer in Korea. The objective of this study was to demonstrate our clinical experience with limited PLND and the difference in its yield between open retropubic radical prostatectomy (RRP) and robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer patients in Korea. MATERIALS AND METHODS: We retrospectively analyzed 601 consecutive patients undergoing radical prostatectomy and bilateral limited PLND by either RRP (n=247) or RALP (n=354) in Asan Medical Center. All patients were divided into three groups according to the D'Amico's risk stratification method. Clinicopathologic data, including the yield of lymph nodes, were thoroughly reviewed and compared among the three risk groups or between the RRP and RALP subjects. RESULTS: The mean patient age was 64.9 years and the mean preoperative prostate-specific antigen was 9.8 ng/ml. The median number of removed lymph nodes per patient was 5 (range, 0 to 20). The numbers of patients of each risk group were 167, 199, and 238, and the numbers of patients with tumor-positive lymph nodes were 1 (0.6%), 4 (2.0%), and 17 (7.1%) in the low-, intermediate-, and high-risk groups, respectively. In the high-risk group, the lymph node-positive ratio was higher in RRP (14.9%) than in RALP subjects (2.4%). CONCLUSIONS: We speculate that limited PLND may help in prostate cancer staging in intermediate- and high-risk prostate cancer groups. RRP is a more effective surgical modality for PLND than is RALP, especially in high-risk prostate cancer groups.

Clinical Experience with Limited Lymph Node Dissection for Prostate Cancer in Korea: Single Center Comparison of 247 Open and 354 Robot-Assisted Laparoscopic Radical Prostatectomy Series

PURPOSE: There are limited data on the role of limited pelvic lymph node dissection (PLND) in patients with prostate cancer in Korea. The objective of this study was to demonstrate our clinical experience with limited PLND and the difference in its yield between open retropubic radical prostatectomy (RRP) and robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer patients in Korea. MATERIALS AND METHODS: We retrospectively analyzed 601 consecutive patients undergoing radical prostatectomy and bilateral limited PLND by either RRP (n=247) or RALP (n=354) in Asan Medical Center. All patients were divided into three groups according to the D'Amico's risk stratification method. Clinicopathologic data, including the yield of lymph nodes, were thoroughly reviewed and compared among the three risk groups or between the RRP and RALP subjects. RESULTS: The mean patient age was 64.9 years and the mean preoperative prostate-specific antigen was 9.8 ng/ml. The median number of removed lymph nodes per patient was 5 (range, 0 to 20). The numbers of patients of each risk group were 167, 199, and 238, and the numbers of patients with tumor-positive lymph nodes were 1 (0.6%), 4 (2.0%), and 17 (7.1%) in the low-, intermediate-, and high-risk groups, respectively. In the high-risk group, the lymph node-positive ratio was higher in RRP (14.9%) than in RALP subjects (2.4%). CONCLUSIONS: We speculate that limited PLND may help in prostate cancer staging in intermediate- and high-risk prostate cancer groups. RRP is a more effective surgical modality for PLND than is RALP, especially in high-risk prostate cancer groups.

Efficacy and Safety of Low-Dose Propiverine in Patients with Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia with Storage Symptoms: A Prospective, Randomized, Single-Blinded and Multicenter Clinical Trial

PURPOSE: The aim of this study was to evaluate whether low-dose anticholinergics combined with an alpha1-receptor antagonist would continue the effect of an alpha-blocker, decrease the side effects of anticholinergics, and improve the symptoms of lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). MATERIALS AND METHODS: Two hundred nine men with LUTS/BPH with storage symptoms (International Prostate Symptom Score [IPSS] > or =12; storage symptoms > or =4) were randomly assigned in a prospective, multicentered, and single-blind fashion to either the control group (alfuzosin 10 mg, once daily) or the combined group (alfuzosin 10 mg, once daily, and propiverine 10 mg, once daily) for 2 months. IPSS, maximal urinary flow rate (Qmax), and postvoid residual volume (PVR) were used to grade symptoms, side effects, and the impact on quality of life (QoL) at the start of the study and after 1 and 2 months. RESULTS: There were no significant differences in patient background, including age, prostate size, Qmax, and PVR, between the control group and the combined group. In the combined group, the IPSS total score and the IPSS storage symptom score were significantly improved compared with the control group. The IPSS voiding symptom score, QoL, Qmax, and PVR did not differ significantly. There were no serious side effects in either group. CONCLUSIONS: Management with an alpha1-receptor antagonist combined with a low-dose anticholinergic improved the total score and storage symptom score of the IPSS compared with alpha1-receptor antagonist only group without causing serious side effects. This initial combination medication can be considered an effective and safe treatment modality for LUTS/BPH patients with storage symptoms.

Efficacy of Anticholinergics for Chronic Prostatitis/Chronic Pelvic Pain Syndrome in Young and Middle-Aged Patients: A Single-Blinded, Prospective, Multi-Center Study / 대한배뇨장애요실금학회지

PURPOSE: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) exhibits variable lower urinary tract symptoms (LUTS). The aim of this study was to evaluate the incidence of LUTS and the efficacy of an anticholinergic agent in young and middle-aged CP/CPPS patients. METHODS: Ninety-six men with CP/CPPS were randomly assigned in a single-blind fashion and received either ciprofloxacin (group 1, 49 patients) or ciprofloxacin and solifenacin (5 mg/day; group 2, 47 patients) for 8 weeks. The National Institutes of Health chronic prostatitis symptom index (NIH-CPSI), the International Prostate Symptom Score (IPSS), and the International Index of Erectile Function-5 (IIEF-5) were used to grade the patients' symptoms and the quality of life impact at the start of the study, and at 4 and 8 weeks from the initiation of the study. RESULTS: There was no significant difference between groups 1 and 2 with respect to age, duration of disease, or sub-domains of the IPSS, NIH-CPSI, or IIEF-5 at baseline. Of these patients, 67.4% had LUTS. Statistically significant differences were determined via the NIH-CPSI for total score and the pain and urinary domain scores. Statistically significant differences were determined via the IPSS for total score and the storage domain score. The total score of the IIEF-5 increased, but the change was not significant. There was no statistically significant difference in residual urine. CONCLUSIONS: Many CP/CPPS patients had LUTS. Solifenacin in CP/CPPS demonstrated improvements in the NIH-CPSI and the IPSS total score and storage score. Storage factors significantly improved via the NIH-CPSI and IPSS assessments in the solifenacin treatment group.

Changes in Serum Prostate-Specific Antigen after Treatment with Antibiotics in Patients with Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia with Prostatitis / 대한배뇨장애요실금학회지

PURPOSE: Many urologists have performed prostate biopsy in men with a high level of prostate-specific antigen (PSA) alone. However, high levels of PSA may be induced by infection. We studied the effects of antibiotics on serum total PSA and PSA density (PSAD) in men with total PSA between 4 and 10 ng/ml and normal digital rectal examination (DRE) and transrectal sonographic findings. MATERIALS AND METHODS: From January 2005 to October 2009, a total of 107 patients with complaints of lower urinary tract symptoms (LUTS) or benign prostatic hyperplasia (BPH) were evaluated. To be included in this study, patients had to be at least 50 years old, have a palpably normal DRE, have infection in the prostate, have a total serum PSA of 4 to 10 ng/ml, and have transrectal ultrasound findings that did not show a hypoechoic lesion in the prostate. Only patients in whom the PSA level was rechecked after short-term antibiotics administration (8 weeks) were included. Serum PSA and PSAD were measured before transrectal ultrasound or EPS and after 8 weeks of treatment with antibiotics (quinolone). Age, prostate volume, serum PSA, PSAD, and PSA rate of change were compared. RESULTS: The mean age of the patients was 66.3 years. The mean prostate size was 48.8+/-24.9 g. Forty patients had a high level of PSAD. Total PSA and PSAD significantly decreased after treatment (p<0.05). In 45 of the 107 men, total PSA after antibiotics treatment was normalized (less than 4 ng/ml). PSAD after treatment was normalized (less than 0.15 ng/ml/cm3) in 23 of the 40 patients with a high level of PSAD. Conclusion: Antibiotics treatment for at least 8 weeks in BPH patients with an increased PSA level (4-10 ng/ml), infection, and normal DRE and transrectal sonographic findings may decrease serum PSA significantly. However, because the PSA level was not decreased to the normal range (less than 4 ng/ml) in all patients, it seems that antibiotics therapy before prostatic biopsy is not necessary.