Day Temperature Difference and Aggravation of Low Urinary Tract Symptom in Benign Prostate Hypertrophy Patients in Korea: A National Health Insurance Service-National Cohort-based Study.

OBJECTIVE: To investigate the symptom deterioration of patients with benign prostatic hyperplasia (BPH) according to the difference in daily temperature. PATIENTS AND METHODS: From the National Health Insurance Service database, we collected and analyzed data on patients with BPH in 6 major metropolitan areas in Korea between January 2008 and December 2017. We investigated the rate of emergency room visits as well as the rate of urethral catheter insertion. RESULTS: In total, 1,446,465 patients were enrolled in this study. When the daily temperature difference was below 4°C, 28.5 patients visited the emergency room daily, while 42.2 patients visited the emergency room daily when the daily temperature difference exceeded 14°C. When the daily temperature difference was more than 14°C, about 48.0% more patients visited the emergency room than when the daily temperature difference was below 4°C. After visiting the emergency room, there were 11.9 patients who had a catheter inserted daily at the daily temperature difference below 4°C. When the daily temperature difference was more than 14°C, the number of catheter insertion cases was 17.8 patients daily, which was 49.2% higher than that of below 4°C. By time, surgery was performed most frequently within 3 months after visiting the emergency room. CONCLUSION: Day temperature difference appear to be related to the Lower urinary tract symptom of BPH patients.

Comparison of bone mineral loss by combined androgen block agonist versus GnRH in patients with prostate cancer: A 12 month-prospective observational study.

The multi-centre, prospective, observational study was designed to examine the efficacy of continuous combined androgen block (CAB) vs. GnRH agonist monotherapy in terms of bone mineral density (BMD) change during 12 months post-androgen deprivation therapy (ADT) in Asian prostate cancer patients. Multiple regression analysis and estimated the 10-year probability of major fractures among the patients with Fracture Risk Assessment Tool were conducted to investigate the underlying factors affecting BMD. Paired t-test to evaluate the change of BMD from baseline to 12 month, and two sample t-test to examine the difference of BMD changes were used between two groups. BMD significantly decreased in both the CAB and GnRH groups, with no group wise differences. The proportion of osteopenia or osteoporosis was slightly increased after the 12-month post-ADT. Ten-year probability of hip fracture and major osteoporotic fracture was approximately 3% and 5%, respectively. In conclusion, a significant decrease of BMD by 12-month ADT was observed without any differences between the two groups, whereas ADT-related BMD loss did not induce detrimental effects on bone health in terms of increased bone fracture risk. This was the first prospective study on BMD changes as a predictor of fracture during ADT in an Asian population.

Palliative care of malignant ureteral obstruction with polytetrafluoroethylene membrane-covered self-expandable metallic stents: initial experience.

PURPOSE: We assessed the efficacy and safety of insertion of a polytetrafluoroethylene membrane-covered self-expandable metallic stent (UVENTA stent) for palliation of malignant ureteral obstruction on the basis of our early results. MATERIALS AND METHODS: Eighteen patients underwent UVENTA stent insertion for extrinsic malignant ureteral obstructions of 20 ureters. The UVENTA stents were deployed retrogradely under cystoscopy and fluoroscopy. Candidates for the procedure had preexisting double-J stents that were nonfunctional or caused excessive bladder irritation. We recorded the success and patency rate in addition to any complications associated with the procedure. RESULTS: The mean length of obstruction was 10.6 cm (range, 2 to 20 cm). Two ureters were obstructed in the upper ureter, 9 in the lower ureter, and 9 in multiple levels of ureter. Simultaneous balloon dilation was performed in 12 ureters. UVENTA stents were successfully inserted in all patients. No obstruction of the UVENTA stents occurred during the mean follow-up period of 7.3 months (patency rate 100%), but de novo ureteral obstruction developed in 4 ureters. There were no instances of stone formation, hyperplastic reaction, encrustation, or migration. Abnormally elevated serum creatinine decreased to normal levels and hydronephrosis gradually resolved during the 4 weeks after UVENTA insertion. No significant complications developed except for transient and self-limiting hematuria and mild lower abdominal pain. CONCLUSIONS: UVENTA stents may relieve malignant ureteral obstruction safely and easily. Long-term follow-up is necessary to assess the role of this stent in the treatment of malignant ureteral obstruction.

Ureteral injury in gynecologic surgery: a 5-year review in a community hospital.

PURPOSE: We reviewed the cases of ureteral injury during gynecologic surgeries in a community hospital and attempted to find possible options for alleviating these distressing situations. MATERIALS AND METHODS: A total of 2,927 patients underwent gynecologic surgeries in the last 5 years at our hospital. We retrospectively analyzed the cases, particularly the possible risk factors and management according to the time of detection of the injury. Thirty-five cases (1.2%) were identified with ureteral injury in a total of 2,927 gynecologic surgeries. Risk factors included endometriosis, pelvic inflammatory disease, previous pelvic surgery, history of pelvic radiation, and congenital anomalies. Among 2,927 patients, 522 had predisposing factors for ureteral injuries. RESULTS: The incidence of ureteral injury in laparoscopic cases was 1.1%, similar to the cases of laparotomy (1.2%). The rate of ureteral injury was significantly higher in the group with risk factors (2.7%) than in the group without risk factors (0.9%; p=0.002). Prophylactic ureteral stenting was performed in 101 of 522 patients with risk factors according to the gynecologic surgeon's preference. The injury rate (1.0%) in the stenting group was lower than that in the non-stenting group (3.1%; p=0.324). Management of ureteral injuries was successful in all cases. Of the patients with postoperatively diagnosed injuries, two patients were managed with secondary procedures, such as retrograde balloon dilatation or ureteroneocystostomy. CONCLUSIONS: The incidence of ureteral injury was significantly higher in cases having risk factors than in cases without risk factors. Surgeons should be cautious to avoid ureteral injury during gynecologic surgery, especially in patients with risk factors.

Progression of prostate cancer despite an extremely low serum level of prostate-specific antigen.

A 61-year-old man who had been diagnosed with prostate cancer 9 years ago and had been treated with pelvic irradiation and intermittent androgen deprivation therapy visited the emergency room because of back pain and weakness in both legs. Spine magnetic resonance imaging showed a lumbar epidural mass and spine metastasis. The whole-body workup revealed multiple metastases to the lymph nodes, bone, liver, and lung. The serum prostate-specific antigen was 0.02 ng/ml. He underwent laminectomy, posterior fixation, and epidural mass excision, and metastatic adenocarcinoma from the prostate was diagnosed. The patient underwent 1 cycle of docetaxel-based chemotherapy. More chemotherapy could not be done because of his general weakness. The patient died one month later of multiple organ failure.

Voiding and sexual function after autonomic-nerve-preserving surgery for rectal cancer in disease-free male patients.

PURPOSE: We evaluated the effects of surgery for rectal cancer on postoperative voiding and sexual function over the course of time. MATERIALS AND METHODS: Data from 28 patients who underwent autonomic nerve preserving rectal cancer surgery were retrospectively analyzed. Operations were performed between October 2005 and July 2007 and all patients were followed-up for more than 3 years. Preoperatively, all patients underwent urodynamic studies including uroflowmetry, and filled out the International Prostate Symptom Score (IPSS). The evaluation of sexual function consisted of Erectile Function domain score in International Index of Erectile Function (IIEF-EFD) and Ejaculation domain score in Male Sexual Health Questionnaire (MSHQ-EjD). Data from uroflowmetry and questionnaires were examined. RESULTS: At 3 years postoperatively the prostate volume was similar to the preoperative value (p=0.727). There were no statistically significant postoperative changes in the average maximum flow rate (15.9 ml/s vs. 16.2 ml/s, p=0.637) and post-void residual urine volume (34.7 ml vs. 36.8 ml, p=0.809). No statistically significant differences were observed in the IPSS (13.2 vs. 12.2, p=0.374). However, although pelvic autonomic nerve preservation have been performed, a significant proportion of rectal cancer patients suffer from sexual dysfunction and the average of IIEF-EFD and MSHQ-EjD scores was decreased postoperatively until 3 years (25.1 vs. 16.1 and 28.3 vs. 14.2 respectively, p<0.001). CONCLUSIONS: Voiding function was not affected after autonomic nerve-preserving rectal cancer surgery, however sexual function was significantly aggravated. We recommend that the baseline genitourinary function should be evaluated before the treatment for male rectal cancer patients, and penile rehabilitation is necessary for their quality of life after treatment.

Significance of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography for the postoperative surveillance of advanced renal cell carcinoma.

OBJECTIVES: To evaluate the role of (18)F-fluorodeoxyglucose (FDG) positron-emission tomography (PET)/computed tomography (CT) for the surveillance of patients with renal cell carcinoma (RCC) who have a high risk of local recurrence or distant metastasis, by comparing the results with those of conventional imaging methods. PATIENTS AND METHODS: Sixty-three patients with RCC had conventional imaging studies and FDG PET/CT during the follow-up after surgical treatment. Their pathological stages were T2 in 28 patients, T3a in 14, T3b in 19 and T4 in two; lymph-node or distant metastases were present in 12 patients. Suspicious recurrent or metastatic lesions were confirmed by histopathology or by clinical follow-up. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of conventional surveillance methods and FDG PET/CT were analysed. The difference in the accuracy of FDG PET/CT by nuclear grade and histological subtype of tumours was also assessed. RESULTS: The FDG PET/CT accurately classified the presence of a recurrence or metastasis in 56 (89%) patients. FDG PET/CT had an 89.5% sensitivity, 83.3% specificity, 77.3% positive predictive value, 92.6% negative predictive value, and 85.7% accuracy in detecting recurrence or metastasis, which was not significantly different from the results with conventional methods. Moreover, the accuracy of the FDG PET/CT by nuclear grade and histological subtypes was not significantly different. CONCLUSION: For the surveillance of high-risk RCC, FDG PET/CT had results that were as good as conventional methods and were not influenced by the nuclear grades of cancer cells. In addition, it was possible to examine all organ systems in one procedure, and there was no need for contrast agents, that can damage renal function. Therefore, FDG PET/CT might replace conventional methods.

Relative proportions of tissue components in the prostate: are they related to the development of symptomatic BPH in Korean men?

OBJECTIVES: To investigate the high prevalence of lower urinary tract symptoms in Korean men with a small prostate, we studied the proportions of histologic components of prostatic adenoma in patients with symptomatic benign prostatic hyperplasia. METHODS: Prostatic adenoma specimens were obtained from men with symptomatic benign prostatic hyperplasia who underwent open prostatectomy or transurethral resection of the prostate. Patients were divided into three groups according to the prostate volume as measured by preoperative transrectal ultrasonography (group 1, 20 to 40 cm3, 21 men; group 2, 41 to 80 cm3, 22 men; and group 3, greater than 80 cm3, 23 men). The age distribution and the severity of symptoms were comparable in these three groups (P > 0.05). The proportion of the stroma in the prostatic adenoma and the proportions of smooth muscle, collagen types I, II, III, and V, fibronectin, and laminin in stromal tissue were determined using automatic image analyzer quantitatively. RESULTS: The proportions of the stroma in the prostatic adenoma specimens of groups 1 and 2 were significantly greater than in group 3 (P < 0.05). The proportions of smooth muscle, collagen types I, III, and V, fibronectin, and laminin were not significantly different in the three groups (P > 0.05). The relative smooth muscle proportion in the prostatic adenoma (proportion of stroma x proportion of smooth muscle in stromal tissue) in groups 1 and 2 was significantly greater than in group 3 (P < 0.05). CONCLUSIONS: These results suggest that the dynamic component of bladder outlet obstruction, which is mediated by smooth muscle tone, may play a more important role in the development of symptomatic benign prostatic hyperplasia in Korean men.

Prevalence and epidemiologic characteristics of urolithiasis in Seoul, Korea.

OBJECTIVES: To study the epidemiologic details of urolithiasis in Seoul, Korea. The prevalence of urolithiasis varies by different regions in the world and has been reported to be 4% to 15%. METHODS: A total of 2643 persons 40 to 79 years old living in Seoul were selected by stepwise random sampling. Questionnaires were used and completed by trained interviewers concerning whether the subjects had experienced urinary stone disease at any time in their life. RESULTS: Of 2643 persons interviewed, 65 experienced 78 episodes of urinary stone formation in their lifetime. Calibrated after the Seoul population census, the overall standardized lifetime prevalence rate was estimated to be 3.5%, 6.0% in men and 1.8% in women. The point prevalence rate was estimated to be 0.9%, 1.9% in men and 0.3% in women. Most of the urinary stone diseases were diagnosed at the fifth decade. Kidney stones in family members were present in 8.1% of patients with stones and 4.1% of stone-free control individuals. Twenty percent of the patients with stones experienced recurrences. CONCLUSIONS: In this first systematically assessed epidemiologic survey about the rate of urolithiasis in Korea, 6.0% of Korean men and 1.8% of women are expected to experience urinary stone disease during their lifetime.