The Correlation of an ICS-male Questionnaire for Lower Urinary Tract Symptoms and Bladder Outlet Obstruction Parameters in Korea / 대한비뇨기과학회지

PURPOSE: We investigated the prevalence of lower urinary tract symptoms (LUTS), and the inconvenience of each symptom, using an ICS-male Questionnaire (ICS-mQ) in Korean man. We also evaluated the relationships between symptoms, prostate volume and urodynamic parameters of a bladder outlet obstruction (BOO). MATERIALS AND METHODS: 180 male LUTS patients, from 7 urological institutions, were enrolled in this study. The ICS-mQ was used to measure the severity of the symptoms, with a bothersomeness scale. Transrectal sonography and urodynamic studies, including Schaefer linear passive urethral resistance relation (L-PURR), were performed. RESULTS: The 5 most frequent symptoms were voiding symptoms, such as reduced stream, terminal dribbling, incomplete emptying, intermittency and hesitancy, in that order. However, the 5 most bothersome symptoms included 2 voiding, and 3 storage, symptoms, such as incomplete emptying, urge incontinence, pain in bladder, nocturnal incontinence and hesitancy. 34.4% of the nocturia patients felt quite, or severely, bothered, but only 1.1% felt no problem. The mean value of estimated prostate volume, by sonography, was 29.8+/-14.1ml. There were no correlations between the severity of symptoms and the prostate size. There were also little, or no, correlations between a wide range of symptoms and the urodynamic parameters of BOO. CONCLUSIONS: The most frequent symptoms of male patients with LUTS are voiding symptoms, but they suffered more from storage, than from voiding, symptoms. The severities of the symptoms, or the bothersomeness, were not correlated with the prostate size or the urodynamic parameters of a bladder outlet obstruction. Therefore, the relief of a bladder outlet obstruction is not crucial to relieve the symptoms.

The Correlation of an ICS-male Questionnaire for Lower Urinary Tract Symptoms and Bladder Outlet Obstruction Parameters in Korea / 대한비뇨기과학회지

PURPOSE: We investigated the prevalence of lower urinary tract symptoms (LUTS), and the inconvenience of each symptom, using an ICS-male Questionnaire (ICS-mQ) in Korean man. We also evaluated the relationships between symptoms, prostate volume and urodynamic parameters of a bladder outlet obstruction (BOO). MATERIALS AND METHODS: 180 male LUTS patients, from 7 urological institutions, were enrolled in this study. The ICS-mQ was used to measure the severity of the symptoms, with a bothersomeness scale. Transrectal sonography and urodynamic studies, including Schaefer linear passive urethral resistance relation (L-PURR), were performed. RESULTS: The 5 most frequent symptoms were voiding symptoms, such as reduced stream, terminal dribbling, incomplete emptying, intermittency and hesitancy, in that order. However, the 5 most bothersome symptoms included 2 voiding, and 3 storage, symptoms, such as incomplete emptying, urge incontinence, pain in bladder, nocturnal incontinence and hesitancy. 34.4% of the nocturia patients felt quite, or severely, bothered, but only 1.1% felt no problem. The mean value of estimated prostate volume, by sonography, was 29.8+/-14.1ml. There were no correlations between the severity of symptoms and the prostate size. There were also little, or no, correlations between a wide range of symptoms and the urodynamic parameters of BOO. CONCLUSIONS: The most frequent symptoms of male patients with LUTS are voiding symptoms, but they suffered more from storage, than from voiding, symptoms. The severities of the symptoms, or the bothersomeness, were not correlated with the prostate size or the urodynamic parameters of a bladder outlet obstruction. Therefore, the relief of a bladder outlet obstruction is not crucial to relieve the symptoms.

The Prognostic Difference between the Invasive Bladder Cancer at the Initial Diagnosis and the Invasive Bladder Cancer Progressed from Superficial / 대한비뇨기과학회지

PURPOSE: This study evaluated the prognostic differences in invasive cancer that progressed from a superficial transitional cell carcinoma (TCC) compared to an already invasive TCC at the time of the initial presentation. MATERIALS AND METHODS: Seventy-one patients who had a radical cystectomy performed for an invasive TCC were enrolled in this study. They were divided into two groups. In the first group, the patients were diagnosed as a superficial TCC at initially, which progressed to an invasive tumor. The second group consisted of patients who were diagnosed with invasive TCC at the time of the initial diagnosis. Two groups were compared with regard to the TNM stage, Ash grade, presence of accompanying carcinoma in-situ and survival rate. RESULTS: The group with invasive cancer at the time of the initial presentation had a significantly higher grade than the progressed group. The five-year survival rate was lower in the progressed group. Moreover, Kaplan-Meier analysis showed it was statistically significant (p=0.04). CONCLUSIONS: The grade was higher and the five-year survival rate was lower in the group with invasive cancer at the time of the initial presentation. Therefore, the invasive TCC at the initial diagnosis might take a more aggressive nature than the progressed group.

Functioning Adrenocortical Carcinoma in a Child / 대한비뇨기과학회지

Adrenocortical carcinoma is a rare tumor in children. This tumor is more likely to be hormonally active in children than in adults and tends to cause a variety of symptoms. These tumors are usually diagnosed at the advanced stages and have a dismal prognosis. Here we report a case of a functioning adrenocortical carcinoma in a child with a review of the relevant literature.

Primary Vesical Actinomycosis: A Case Diagnosed by Multiple Transabdominal Needle Biopsies

Primary vesical actinomycosis is an extremely rare disease. In most cases it is misdiagnosed as vesical or urachal tumor and usually diagnosed through post-operative pathologic confirmation. Here we report a case of primary vesical actinomycosis confirmed by preoperative repeated multiple transabdominal biopsies. The patient was a 49-yr-old woman who presented with frequency, dysuria, and intermittent gross hematuria for 2 months. Computed tomography and cystoscopic examination showed broad-based, edematous, and protruding mass at the dome and anterior portion of the bladder. The clinical and imaging findings of the patient initially suggested vesical malignancy. Transurethral resection and multiple biopsies of the mass were performed. Pathologic examination demonstrated fibrosis with chronic inflammation. We performed repeated transabdominal multiple needle biopsies for further pathologic confirmation. Histopathologic examination demonstrated typical sulfur granules, which were consistent with actinomycosis.

The Correlation of Urodynamic Study with Prostate Volume Parameters in the Evaluation of the BPH / 대한비뇨기과학회지

PURPOSE: It is difficult to assess the severity of benign prostatic hyperplasia (BPH) both objectively and quantitatively. This study aims to examine the predictive value of ultrasonic measurements obtained by transrectal ultra-sonography (TRUS) for infravesical obstruction as evaluated by pressure flow study (PFS). MATERIALS AND METHODS: Among the men over 50 years old with symptoms of BPH, 69 men in which bladder outlet obstruction were confirmed by PFS were prospectively analysed. All men were requested to undergo measurement of international prostate symptom score (IPSS), TRUS and PFS. IPSS and urodynamic parameters were compared to prostate volume parameters using simple and multiple regression analysis. RESULTS: Simple regression analysis demonstrated that prostate total volume (PV) and presumed circular area ratio (PCAR) correlated significantly with all urodynamic parameters. Maximal uroflow (Qmax) was significantly correlated with all prostate volume parameters. Multiple regression analysis showed that PCAR was the only significant independent determinant of IPSS and urodynamic parameters. A receiver operator characteristics curve analysis showed that 0.8 was the most suitable cutoff value of PCAR for the prediction of infravesical obsruction with a diagnostic accuracy of 75.3%. CONCLUSIONS: PCAR was an only significant independent determinant of the severity of BPH using a cutoff value 0.8. Conclusively, PCAR was thought to be a valuable volume parameters in predicting bladder outlet obstruction caused by BPH without measuring pressure-flow study.

Comparison of the Clinical Effects after Finasteride Treatment for Benign Prostatic Hyperplasia according to the Transition Zone Volume and Transition Zone Index / 대한비뇨기과학회지

PURPOSE: Recent studies suggest that the symptomatic improvement in benign prostatic hyperplasia significantly related with transition zone volume (TZV). The purpose of this study was to determine the clinical significance of TZV and transition zone index (TZI) in changes of prostate volume (PV) and clinical parameters following finasteride therapy. MATERIALS AND METHODS: 140 patients over 50 years of age with symptomatic benign prostatic hyperplasia were treated with finasteride (5mg/d) for 12 months and underwent transrectal ultrasound evaluation of PV and TZV prior to initiating therapy and after 12 months. Patients were grouped according to the results of PV (> OR =40ml or OR =0.45 or OR =2.5 or <2.5). The responders was determined as improvement in peak flow rate more than 3mL/sec. RESULTS: PV decreased by 14.11% in patients with TZI less than 0.45, while the decrease was 19.25% for men with TZI greater than 0.45 (p<0.01). In addition, PV was significantly decreased by 16.72% in patients with PV less than 40cc and TZI greater than 0.45 (p<0.01). PV decreased by 17.37% in patients with PSA less than 2.5, while the decrease was 18.92% in men with PSA greater than 2.5. In responders, only TZI was significantly different among PSA, PV and TZI (p<0.05). CONCLUSIONS: Treatment effect of finasteride on symptomatic benign prostatic hyperplasia patients was increased in proportion to enlarged PV, increased TZI, increased PSA. TZI was a useful proxy for predicting clinical outcomes in initiating finasteride therapy on benign prostatic hyperplasia.

The Effects of Sildenafil Citrate as an Intracavernosal Agent / 대한남성과학회지

PURPOSE: Treatment of impotence has advanced considerably by an orally active, effective and well-tolerated drug, sildenafil citrate. However, Sildenafil citrate is not so effective for the treatment of severe organic impotence patients. Intracavernosal injection of vasoactive substance is still the most effective therapy for those patients but side effects, e.g. pain, priapism, require a more comfortable therapy. We performed this study to assess the feasibility of sildenafil citrate as a new intracavernosal agent. MATERIALS AND METHODS: In New Zealand white male rabbits (n=11), relaxations of precontracted cavernosal smooth muscle strips were studied after administration of sildenafil citrate, acetylcholine and sodium nitroprusside (SNP), respectively. In separate in vivo experiment, changes of intracavernosal pressure (ICP), duration of increased ICP and changes of systemic arterial blood pressure after retrograde selective internal pudendal arterial administration of four separate doses (0.1 mg, n=5; 0.3 mg, n=6; 0.5 mg, n=7; 1.0 mg, n=7) of sildenafil citrate were monitored in adult male cats (n=25). RESULTS: Acetylcholine, SNP and sildenafil citrate effectively relaxed the precontracted strips in a dose-dependent manner (3x10 8-3x10 3 M), respectively. Maximal relaxation of strips to acetylcholine, SNP and sildenafil citrate were 50.11%, 98.65%, and 68.32%, respectively. The order of potency was acetylcholine