Current Evidence for the Treatment of Bladder Cancer / 이화의대지

Bladder cancer is the second most common malignancy in urological field. Most new cases are diagnosed as non-muscle invasive bladder cancer (NMIBC), which includes Ta, T1 or carcinoma in situ. Initial management of NMIBC is endoscopic resection, which allows both treatment and pathological staging. Urologist should consider adjuvant intravesical chemotherapy or Bacillus Calmette-Guerin (BCG) immunotherapy, depending on the tumor grade or stage to prevent recurrence and progression. Patients with muscle invasive bladder cancer (MIBC) are best treated with radical cystectomy. However, radical cystectomy should be considered even in patients with NMIBC with high risk of progression and BCG refractory tumors. Delay of radical cystectomy in these patients might lead decreased disease specific survival. Patients treated by radical cystectomy should undergo any form of the urinary diversion. Ileal conduit is still most common method for urinary diversion. Orthotopic neobladder is generally performed by experienced hands in high volume center. Patients undergoing orthotopic neobladder should be educated and manually skillful to manipulate their diversion. Neoadjuvant cisplatin-based chemotherapy is recommended based on level 1 evidence with survival benefit. Recent updated meta-analysis also demonstrated survival benefit in patients with MIBC treated by adjuvant chemotherapy.

Body Image Following Radical Cystectomy and Ileal Neobladder or Conduit in Korean Patients

PURPOSE: The aim of this study was to compare the body images of patients who underwent radical cystectomy with an orthotopic ileal neobladder or an ileal conduit. MATERIALS AND METHODS: A total of 114 adult patients who underwent radical cystectomy between March 2006 and December 2012 at a single institution, Ewha Womans University Mokdong Hospital in Korea, were evaluated in this retrospective chart-review study. Forty-two patients (29 orthotopic ileal neobladder and 13 ileal conduit) who completed questionnaires were included in the final analysis; the remaining patients were excluded. The patients were assessed with two questionnaires: the Korean version of the Body Image Scale (K-BIS) and the self-designed questionnaire. RESULTS: The results did not differ significantly by age at surgery, time from surgery to survey, pathologic stage, grade, histologic subtype, education, residency, or Eastern Cooperative Oncology Group performance status, but did differ significantly by age at survey and sex. The mean summary score for K-BIS showed significant differences between the two groups (p=0.001). We found that patients who underwent an orthotopic ileal neobladder had a significantly better body image. The self-designed questionnaire score was not significantly different between the two groups (p=0.572). CONCLUSIONS: In our retrospective analysis, patients who underwent orthotopic ileal neobladder had a superior body image compared with those who underwent an ileal conduit.

A Comparative Study of Clinical Symptoms and Treatment Outcomes of Acute Bacterial Prostatitis According to Urine Culture

PURPOSE: Because acute bacterial prostatitis (ABP) is an urgent condition of the prostate but prostatic massage is contraindicated at the onset of ABP, clinical symptoms and urine tests are used for diagnosis. In this study, we compared the clinical symptoms and treatment outcomes of patients with negative urine culture results, to whom only empirical antibiotics were administered, with those of patients with positive urine culture results. MATERIALS AND METHODS: Patients were divided into two groups according to the results of urine culture. Then, the clinical symptoms and course of each group were analyzed. In addition, age, symptoms, antibiotics, mean inpatient and outpatient length of treatment, and the treatment outcome of each group were also analyzed. RESULTS: Of the total 144 patients, the positive urine culture group consisted of 51 patients (35.4%) and the most frequent bacterial strain causing ABP was reported to be Escherichia coli. Fever and storage symptoms were significantly more common in the positive urine culture group than in the negative urine culture group (p=0.031 and 0.047, respectively). Only inpatient treatment was significant longer in the positive urine culture group than in the negative urine culture group (p<0.05). The mean length of treatment of inpatients was 4.8+/-2.6 days and 6.2+/-2.9 days in the two groups, respectively. No sequelae such as prostatic abscess or chronic prostatitis were found in either group. CONCLUSIONS: In the treatment of ABP, the use of empirical antibiotics can be expected to have sufficient effects regardless of bacterial culture. However, it is hard to determine the causative bacteria of ABP by urine culture results only.

Prospective Factor Analysis of Alpha Blocker Monotherapy Failure in Benign Prostatic Hyperplasia

PURPOSE: We aimed to determine the treatment of choice criteria for benign prostatic hyperplasia (BPH) by analyzing the factors causing alpha-adrenergic receptor blocker (alpha-blocker) monotherapy failure. MATERIALS AND METHODS: This retrospective study enrolled 129 patients with BPH who were prescribed an alpha-blocker. Patients were allocated to a transurethral resection of prostate (TURP) group (after having at least a 6-month duration of medication) and an alpha-blocker group. We compared the differences between the two groups for their initial prostate volume, serum prostate-specific antigen (PSA), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual urine volume (PVR). RESULTS: Of the 129 patients, 54 were in the TURP group and 75 were in the alpha-blocker group. Statistically significant differences (p<0.05) between the two groups were found in the prostate volume (50.8 ml vs. 34.4 ml), PSA (6.8 ng/ml vs. 3.6 ng/ml), Qmax (6.84 ml/sec vs. 9.99 ml/sec), and IPSS (27.3 vs. 16.8). According to the multiple regression analysis, the significant factors in alpha-blocker monotherapy failure were the IPSS (p<0.001) and prostate volume (p=0.015). According to the receiver operating characteristic (ROC) curve-based prediction regarding surgical treatment, the best cutoff value for the prostate volume and IPSS were 35.65 ml (sensitivity 0.722, specificity 0.667) and 23.5 (sensitivity 0.852, specificity 0.840), respectively. CONCLUSIONS: At the initial diagnosis of BPH, patients with a larger prostate volume and severe IPSS have a higher risk of alpha-blocker monotherapy failure. In this case, combined therapy with 5-alpha-reductase inhibitor (5-ARI) or surgical treatment may be useful.

Prospective Factor Analysis of Alpha Blocker Monotherapy Failure in Benign Prostatic Hyperplasia

PURPOSE: We aimed to determine the treatment of choice criteria for benign prostatic hyperplasia (BPH) by analyzing the factors causing alpha-adrenergic receptor blocker (alpha-blocker) monotherapy failure. MATERIALS AND METHODS: This retrospective study enrolled 129 patients with BPH who were prescribed an alpha-blocker. Patients were allocated to a transurethral resection of prostate (TURP) group (after having at least a 6-month duration of medication) and an alpha-blocker group. We compared the differences between the two groups for their initial prostate volume, serum prostate-specific antigen (PSA), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual urine volume (PVR). RESULTS: Of the 129 patients, 54 were in the TURP group and 75 were in the alpha-blocker group. Statistically significant differences (p<0.05) between the two groups were found in the prostate volume (50.8 ml vs. 34.4 ml), PSA (6.8 ng/ml vs. 3.6 ng/ml), Qmax (6.84 ml/sec vs. 9.99 ml/sec), and IPSS (27.3 vs. 16.8). According to the multiple regression analysis, the significant factors in alpha-blocker monotherapy failure were the IPSS (p<0.001) and prostate volume (p=0.015). According to the receiver operating characteristic (ROC) curve-based prediction regarding surgical treatment, the best cutoff value for the prostate volume and IPSS were 35.65 ml (sensitivity 0.722, specificity 0.667) and 23.5 (sensitivity 0.852, specificity 0.840), respectively. CONCLUSIONS: At the initial diagnosis of BPH, patients with a larger prostate volume and severe IPSS have a higher risk of alpha-blocker monotherapy failure. In this case, combined therapy with 5-alpha-reductase inhibitor (5-ARI) or surgical treatment may be useful.

Can the PDE5 Inhibitor Replace Intracavernosal Injection as a Method for Inducing a Penile Erection during the Evaluation of Erectile Dysfunction Using Penile Duplex Ultrasonography? / 대한비뇨기과학회지

PURPOSE: To clarify whether vardenafil can be used as a substitute for intracavernosal injection as a method of induction of penile erection, we compared the outcome of penile duplex Doppler ultrasonography using both methods in the same patient with erectile dysfunction. MATERIALS AND METHODS: A total of 23 patients underwent penile duplex ultrasonography twice with a one week interval between procedures. Twelve were randomly selected for intracavernosal injection first with prostaglandin E1(PGE1) 20microgram and the remaining 11 were initially treated with oral vardenafil 20mg 1 hour before the Doppler study and in addition had visual sexual stimulation using a head-mounted display during the study. The peak systolic velocity(PSV), end diastolic velocity(EDV) and the degree of maximum erectile response were measured and compared between the two groups. RESULTS: Measurements from the PGE1 treatment were not significantly different from those with the vardenafil treatment. The percentage of compatibility between the two methods with regard to hemodynamic diagnosis and pharmaceutical erectile response was as high as 83%(19 of 23) and 91%(21 of 23), respectively. Both methods were tolerable and safe without severe complications. However, in 4 patients where the diagnosis was uncertain, the injection method provided a more accurate interpretation of the penile vascular status with duplex ultrasonography. CONCLUSIONS: These results suggest that oral vardenafil can be used as an initial method for inducing penile erection when assessing erectile dysfunction with penile duplex Doppler ultrasonography in selected patients with erectile dysfunction.

The Effect of Palliative Transurethral Resection of Prostate(Channel TURP) for Acute Urinary Retention in Patients with Metastatic Prostatic Cancer

PURPOSE: Obstructive voiding difficulties were frequent in the patients with metastatic prostatic cancer, and sometimes acute urinary retention may be developed even though medical treatments. We performed channel transurethral resection of prostate(TURP) as palliative treatment for those patients and reported the results. MATERIALS AND METHODS: Fifteen patients with metastatic prostatic cancer were taken TURP aiming for relief of infravesical obstruction. All patients were under the anti-androgen hormonal therapy and had sudden onset of acute urinary retention. TURP was done under general or epidural anesthesia. After TURP, 30~50 cc ballooning urethral Foley catheter was placed for 4 days. We analyzed voiding parameters comparatively before and 3 months after TURP. RESULTS: The mean age of patients was 75.6+/-5.7 years old. Mean prostatic volume was 47.8+/-1.4 cc. Mean resected prostatic tissue was 6.4+/-2.1 cc. All patients had stage D prostatic cancer. Mean serum PSA was 75.2+/-73.8 ng/ml and mean gleason score was 7.8+/-0.9. After TURP, mean international prostatic symptom score(IPSS) was improved from 25.5+/-2.0 to 13.8+/-2.0, mean quality of life score(QOL) was improved from 4.4+/-0.5 to 2.0+/-0.5, and mean maximum uroflow rate was increased from 5.0+/-1.1 ml/sec to 6.0+/-1.6 ml/sec. All patients did not have any complications according to TURP. CONCLUSION: In patients with metastatic prostatic cancer, channel TURP could be considered as a treatment option to relieve severe obstructive voiding difficulty.

Effect of Tamsulosin on the Expectant Treatment of Lower Ureteral Stones / 대한비뇨기과학회지

PURPOSE: We evaluated the effectiveness of tamsulosin on the expectant treatment for the patients suffering with lower ureteral stones. MATERIALS AND METHODS: A total of 67 patients with stones less than 5mm that were located in the lower ureter were enrolled in the study. The patients were randomly divided into two groups. Group 1 (n=32) received 20mg caroverine (a spasmolytic drug) orally three time a day. Group 2 (n=35) received 0.2mg tamsulosin orally one time a day. The treatment was continued until expulsion of stone or to a maximum of 28 days. All patients were allowed 30mg ketorolac trimethamine intramuscular injections on demand. We compared the two groups for stone size, the expulsion rate, the time to expulsion and use of analgesics. RESULTS: The average stone size was 4.3+/-0.61mm for group 1 and 4.4+/-0.51mm for group 2. No statistical difference between two groups was found for stone size, age and sexual distribution. The expulsion rate was significantly higher in group 2 (82.8%), compared with group 1 (53.1%) (p=0.002). The mean expulsion time was 8.3 days for group 1 and 4.6 days for group 2 (p<0.0001). The average number of intramuscular analgesic injections was 3.9 for group 1 and 1.1 for group 2 (p<0.0001). CONCLUSIONS: Tamsulosin was proved to be effective and safe, as demonstrated by the increased stone expulsion rate, the decreased expulsion time and the reduced use of pain control in the expectant treatment of the lower ureter stones.

Endourologic Procedures and Laparoscopic Surgery in Urology Training Hospitals: The Report of Nationwide Survey / 대한비뇨기과학회지

PURPOSE: To assess the current status of endourology and laparoscopy in Korea. MATERIALS AND METHODS: Using the database directory of the Korean Urological Association, 83 urology training hospitals were identified. A detailed questionnaire was designed and sent by post and e-mail. The questionnaire included questions regarding the number of various endourological and laparoscopic procedures between 1998 and 2002. The questionnaires of those responding were analyzed. RESULTS: Responses were received from 45 hospitals (response rate 54.2%). 133 antegrade and 626 retrograde endourological procedures for urinary strictures were performed during the period of the study in 12 and 35 hospitals, respectively. 42 hospitals (93.3%) were performing shock wave lithotripsy for urinary stone disease. 29 hospitals (64.4%) reported having performed more than one laparoscopic procedure during the five years. The annual total numbers of laparoscopic procedures increased from 217 in 1998 to 725 in 2002. Simple laparoscopic nephrectomy was the most widely accepted procedure, and was being performed in 18 hospitals. Laparoscopic adrenalectomy, radical nephrectomy, diagnostic laparoscopy, laparoscopic renal cyst marsupialization, nephroureterectomy and donor nephrectomy were performed in more than 10 hospitals. However, the actual number of laparoscopic procedures was limited in most hospitals. More than 40 laparoscopic procedures per year were performed by only four hospitals. CONCLUSIONS: This survey revealed an increasing number of endourological and laparoscopic procedures. However, laparoscopy seems to be mainly a larger hospital-based technology in Korea. These results can be utilized as fundamental data for establishing future developmental requirements of endourology and laparoscopy in Korea.

The Effect of Functional Electrical Stimulation(FES) - Biofeedback on Sexual Activity and Quality of Life in Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: Pelvic floor muscles play an important role in female sexual function. Urinary incontinence is one of the complex symptoms of pelvic floor relaxation. The purpose of the present study was to evaluate the effects of behavioral treatment on the sexual life variables and quality of life in stress urinary incontinent women. MATERIALS AND METHODS: Fifty women with clinically and urodynamically proven stress urinary incontinence were randomly selected, and treated with functional electrical stimulation (FES) -Biofeedback. The FES-Biofeedback treatment was performed for 20 min per session, 2 sessions a week, for 6 weeks. The treatment consisted of electrical stimulation (35Hz and 50Hz, simultaneously) for 24 seconds, and the biofeedback, composed of 3 phases of contraction, lasted for 32 seconds. The outcome measures on the sexual life variables and quality of life scales were assessed by the Bristol Female Lower Urinary Tract Symptoms questionnaire and a self-developed questionnaire, based on the Brief index of sexual Functioning for women (BISF-W). RESULTS: The general quality of life scores were significantly improved after 6 weeks of FES-Biofeedback (p<0.05). The quality of orgasms, sexual interest, sexual activity and sexual anxiety were significantly improved after the FES-Biofeedback (p<0.05). Changes in the scores for the degree of satisfaction in those variables also showed statistical significance (p<0.05). CONCLUSIONS: Women with incontinence were dissatisfied with their sexual life due to various symptoms associated with their urinary symptoms or symptoms that result from pelvic floor relaxation. The FES-Biofeedback therapy showed positive effects on improving, not only stress incontinence, but also sexual life variables and the life quality.

Obturator Neuropathy Associated with Tension Free Vaginal Tape Procedure / 대한비뇨기과학회지

TVT (Tension Free Vaginal Tape) is a new simple surgical procedure, with good postoperative outcomes. However, there are possibilities of major complications, which should be considered, such as massive bleeding, bladder or bowel perforations and nerve injury. There is little information on treatment of obturator neuropathy as a result of nerve compression, or injury, caused by a more lateral placement of tape following a TVT procedure. To prevent this complication, the patient's legs should be correctly positioned, enough abduction and not exceeding 60 degrees to avoid excessive flexion.

The Physiologic Effects of the Urocitra in Patients with Urolithiasis / 대한비뇨기과학회지

PURPOSE: To investigate the biochemical change in serum and 24-hour urine after therapy with Urocitra(R) in patients affected by urolithiasis, who had hypocitraturia alone or associated with other metabolic disorder. MATERIALS AND METHODS: One hundred eighteen patients with evidence of 1 or more stone attacks within the last 3 years participated in the present study. They were 78 men and 40 women (6 to 78 years old, with a mean age of 47.01 12.95 years). All of the patients received 15 to 20ml of Urocitra(R)-solution or 5 g of Urocitra(R)-C powder, three or four times daily for 3 months. Before treatment, 24-hour urine and venous blood samples were obtained, while patients were maintained on a random diet, and analyzed for various stone risk factors. After 1 week, 1 month and 3 months of treatment, samples were again obtained and analyzed in the same manner. Thereafter, we compared the biochemical values before and after treatment. RESULTS: In all three follow-up periods Urocitra(R) induced a significant increase in urinary citrate (p<0.001) level. Urinary potassium (p<0.001), pH (p<0.001) and total volume (p<0.05) also increased significantly after 1 and 3 months of therapy, as did urinary citrate excretion in patients with hypocitraturia and normocitraturia. Urocitra(R) did not alter calcium, sodium or phosphorus urinary excretion. There was no significant change of serum chemistry after administration. CONCLUSIONS: Urocitra(R) was effective in increasing urinary pH and citrate. Furthermore, it was relatively free of side effects, except for minor gastrointestinal distress. Thus, our study provides physiological and clinical validation for the use of Urocitra(R) in patients affected by urolithiasis, who have hypocitraturia alone or associated with another metabolic disorder.

Effects Estrogen on the Expression of NOS and Histologic Composition in Rabbit Clitoris / 대한비뇨기과학회지

PURPOSE: Many investigators suggested that changes in hormonal environment in the postmenopausal women functionally or histologically effect the clitoris and vagina. We investigated the mechanism of female se xual dysfunction occurring in the decreased hormonal status, and aimed to establish and experimental base for the hormone replacement in postmenopausal women to correct sexual dysfunction. MATERIALS AND METHODS: Twenty mature female New Zealand white rabbits were randomly divided into three groups; control group, oophorectomy group, estrogen replacement group after oophorectomy. Nitric oxide synthase (NOS) activity and the degree of expression of neuronal NOS (nNOS) and endothelial NOS (eNOS), collagen content in clitoral tissues were analysed. RESULTS: nNOS and eNOS were significantly increased in the oohporectomized group while decreased in the estrogen replacement group (p<0.01). NOS activity showed the similar pattern of change (p<0.05). Oophorectomy induced a significant increase in collagen content, while the ratio of smooth muscle content was increased significantly after the estrogen replacement (p<0.01). CONCLUSIONS: Estrogen deficiency induces collagen synthesis and decreases the content of smooth muscle in clitoris, resulting in a structural relaxation difficulty. We believe that NOS becomes more active to improve the relaxation difficulty and that hormone replacement helps to restore the normal state of smooth muscle relaxation. Considering these findings, we suggest that estrogen down-regulates NOS and its activity.

Questionnaire Based Evaluation of Sexual Activity and Sexual Dysfunction in Korean Women / 대한비뇨기과학회지

PURPOSE: Sexual activity is a highly personal matter and uneasy to measure their problems objectively in view of clinical field. Many investigators have been continued to rely on self-report measures of sexual function. However, there have been few report measuring female sexual function in general population in Korea. This study was aimed to investigate function by self-report measures. MATERIALS AND METHODS: 347 married women was randomly selected and asked to fill the Brief Index of Sexual Function for Women (BISF-W) which was translated into Korean and modified by authors. Three factors-interest/desire, sexual activity, and satisfaction were analyzed. RESULTS: Women were grouped by age at 10-year intervals. 21.5% of women reported to be sexually active during the past moth, and 78.5% was inactive. Most common coital frequency in all age groups pas one-two times per month. 76.1% of women showed passive response in their initiation of sexual activities. Mostly they reach orgasm only by the vaginal intercourse, and overall satisfaction rate was 55.2% including only 25% of fifties groups followed by pain. CONCLUSIONS: In general, Korean women showed less active in their sexual lives, however, they were relatively satisfied to their sexual lives. A larger study and more sophisticated, modified questionnaire, which is more considering specific social, psychological interpersonal factors would be required.

Ultrasound Histogram in TRUS / 대한비뇨기과학회지

No abstract available.

The Early Experiences of Dermofat Strip Pubovaginal Sling / 대한비뇨기과학회지

No abstract available.

The Evaluation of Sexual Function in Patients with Lower Urinary Tract Symptom / 대한비뇨기과학회지

No abstract available.

Surgical Management of the Failed Anti-incontinence Surgery / 대한비뇨기과학회지

PURPOSE: Various surgical methods have been using to treat female stress urinary incontinence. However, significant numbers of those patients suffered from immediate or delayed recurrences. The aims of this study were to analyze the etiology of recurrent stress urinary incontinence and evaluate the efficacy of each operation which was used as methods of treating recurrent stress urinary incontinence. MATERIALS AND METHODS: Data of 16 female patients with recurrent stress urinary incontinence who visited and treated at our urologic department from January 1995 to March 1998 were analyzed. All patients were assessed for their age, types of previous and current anti-incontinence operations, urodynamic findings and final outcomes. RESULTS: Mean age was 48.8 years old. 12 patients were taken anti-incontinence operations only once before recurrence, and 4 patients experienced two times of anti-incontinence operations. Two of 16(12%) patients were diagnosed as anatomic incontinence(AI), 3(19%) patients were diagnosed as intrinsic sphincteric dysfunction(ISD), and 11(69%) patients had both AI and ISD. Two AI patients were finally managed by Raz bladder neck suspension with anterior and posterior colporrhaphy(APR), and Burch colposuspension, respectively. Three ISD patients were treated by sling operation & APR, collagen injection, and Burch colposuspension, repectively. 11 mixed incontinence patients were treated by sling operations & APR(7), Burch colposuspension(3), Stamey`s needle suspension & APR(1). None of 16 patients has developed recurrent urinary incontinence so far. CONCLUSIONS: Basic principle in treating AI is the correction of the urethral hypermobility. However, 81%(13/16) of patients still had urethral hypermobility in spite of previous anti-incontinence surgery, and it seems that those anti-incontinence surgeries were improperly selected or urethral hypermobility reappeared. Patients who showed urinary incontinence in spite of well supported bladder neck suggest the possibility of undetected or secondary ISD. These findings support the importance of selection of proper initial surgical management. In recurrent urinary incontinence, majority of them show undetected or newly appeared ISD component regardless of urethral hypermobility. In those situations, sling operation can be a safe and effective procedure in the management of patients with failed anti-incontinence surgery.

Transrectal Ultrasonography: Error of Prostatic Measurement / 대한비뇨기과학회지

PURPOSE: Transrectal ultrasonography is known to be an effective tool for the determination of prostatic volume. But the irregularity of shape and the limitation of reliability by intra-observer and inter-observer bias may influence over the results. I would like to represent several factors for the error of transrectal ultrasonographic measurement of prostatic volume. MATERIALS AND METHODS: Errors for transrectal ultrasonographic volume determination of the prostate, based on the principle of HWL(Height x Width x Length x pi/6) are presented. Some artificial prostatic models were made and compared between the real volumes and calculated results. The intra-observer error was determined in 39 cases by repeated measurements. The inter-observer error was also determined in 32 cases by repeated measurements of different observer. RESULTS: There were significant discrepancies between real volumes and calculated results and the range of error by shape was -19?38%. The ranges of intra-observer and inter-observer errors with 95% confidence interval were -7.4?6.1% and 2.7?9.9%. CONCLUSIONS: Errors by several factors should be considered for the clinical application of measured prostatic volume by ultrasonography irrespective of its statistical validity and reliability.

Removal of a Strangulating Polyethylene Ring from the Penis with a Heated Blade / 대한남성과학회지

Methods of removing strangulating objects from the penis have been described in many cases. We report a unique method, namely, melting a polyethylene tereftalate ring with a heated blade, which was very effective and safe for removal.