Androgen Deprivation Therapy in Patients with Prostate Cancer is Associated with the Risk of Subsequent Alzheimer's Disease but Not with Vascular Dementia.

PURPOSE: We aimed to investigate the association between androgen deprivation therapy (ADT) and the risk of dementia according to subtypes of dementia in men with prostate cancer. MATERIALS AND METHODS: We performed a nationwide population-based cohort study using the nationwide claims database in Korea. A total of 195,308 men with newly diagnosed prostate cancer were identified between January 2008 and December 2017, and 132,700 men were selected for analysis after applying inclusion and exclusion criteria. The patients were divided into ADT and non-ADT groups. To adjust for imbalances in relevant comorbidities between the groups, exact matching was performed. Study events included newly developed Alzheimer's disease, vascular dementia, and overall dementia. Cox proportional hazard regression models were used. RESULTS: After exact matching, 44,854 men with prostate cancer were selected for the main analysis. In age-adjusted Cox regression analysis, the ADT group was significantly associated with increased risks for overall dementia (hazard ratio [HR], 1.070; 95% confidence interval [CI], 1.009-1.134; p=0.0232) and Alzheimer's disease (HR, 1.086; 95% CI, 1.018-1.160; p=0.0127), compared to the non-ADT group. No difference in vascular dementia risk was observed between the two groups (HR, 0.990; 95% CI, 0.870-1.126; p=0.8792). CONCLUSIONS: The risk of overall dementia increased in men who received ADT. According to dementia subtypes, ADT was associated with an increased risk of Alzheimer's disease, but not with vascular dementia.

Effect of systemic atherosclerosis on overactive bladder symptoms in men with benign prostatic hyperplasia.

OBJECTIVE: Symptoms of male overactive bladder (OAB) may be caused by several systemic pathophysiological factors rather than a single-source etiology. We investigated the clinical factors associated with the severity of OAB symptoms in treatment-naïve men with coexisting benign prostatic hyperplasia. METHODS: We obtained records from a health promotion center database of male patients who visited between March 2019 and February 2020. Men without a history of treatment for lower urinary tract symptoms were evaluated using the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, transrectal ultrasonography, medical history, and carotid duplex ultrasound for the evaluation of atherosclerosis. Benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) was defined as an IPSS of eight points or higher. Patients with comorbidities that may affect their voiding function were excluded. RESULTS: A total of 764 patients were divided into two groups based on their diagnosis: an OAB group and a non-OAB group. The non-OAB group consisted of 627 patients (82.1%) and the OAB group consisted of 137 patients (17.9%). Using multivariable analysis BPH/LUTS was identified as an independent risk factor for OAB. In the OAB group without BPH/LUTS, carotid atherosclerosis was significantly associated with the severity of OAB symptoms. A history of diabetes mellitus was the only variable that was associated with the severity of urinary urgency. Systolic blood pressure was associated with severity of urinary urgency in the OAB group with BPH/LUTS. CONCLUSIONS: Factors associated with male OAB exhibit different pathophysiology in the severity of symptoms depending on the presence of BPH/LUTS. Treatment for atherosclerosis and associated systemic pathophysiological factors could lower OAB symptom severity in male patients without BPH/LUTS.

Development of prediction models of spontaneous ureteral stone passage through machine learning: Comparison with conventional statistical analysis.

OBJECTIVES: To develop a prediction model of spontaneous ureteral stone passage (SSP) using machine learning and logistic regression and compare the performance of the two models. Indications for management of ureteral stones are unclear, and the clinician determines whether to wait for SSP or perform active treatment, especially in well-controlled patients, to avoid unwanted complications. Therefore, suggesting the possibility of SSP would help make a clinical decision regarding ureteral stones. METHODS: Patients diagnosed with unilateral ureteral stones at our emergency department between August 2014 and September 2018 were included and underwent non-contrast-enhanced computed tomography 4 weeks from the first stone episode. Predictors of SSP were applied to build and validate the prediction model using multilayer perceptron (MLP) with the Keras framework. RESULTS: Of 833 patients, SSP was observed in 606 (72.7%). SSP rates were 68.2% and 75.6% for stone sizes 5-10 mm and <5 mm, respectively. Stone opacity, location, and whether it was the first ureteral stone episode were significant predictors of SSP. Areas under the curve (AUCs) for receiver operating characteristic (ROC) curves for MLP, and logistic regression were 0.859 and 0.847, respectively, for stones <5 mm, and 0.881 and 0.817, respectively, for 5-10 mm stones. CONCLUSION: SSP prediction models were developed in patients with well-controlled unilateral ureteral stones; the performance of the models was good, especially in identifying SSP for 5-10-mm ureteral stones without definite treatment guidelines. To further improve the performance of these models, future studies should focus on using machine learning techniques in image analysis.

Effect of training and individual operator's expertise on prostate cancer detection through prostate biopsy: Implications for the current quantitative training evaluation system.

PURPOSE: This study was conducted to evaluate the relevance of training and experience to gaining expertise in prostate biopsy based on an assessment of outcomes from the performance of urology residents. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 10,299 patients who underwent prostate biopsy by 50 operators under a unified urology residency program. The number of prostate biopsies performed by an operator for each patient was used as an indicator of operator experience. Residents were grouped into quartiles according to cancer detection rates in the first 50 and the last 50 procedures. RESULTS: Among 10,299 patients (median age, 67.5 years; median prostate-specific antigen [PSA], 7.04 ng/mL), the overall prostate cancer detection rate and that for patients with PSA <10.0 ng/mL were 37.0% and 25.9%, respectively. Operator experience was a significant predictor for cancer detection in patients with PSA <10.0 ng/mL. Cancer detection rates and the proportion of more advanced prostate cancers were higher in the last 50 cases than in the first 50 cases. Detection rates varied significantly among operator; residents with higher detection rates at training initiation showed even higher detection rates after additional training. CONCLUSIONS: Training that adds to the cumulative experience of a trainee appears to play a meaningful role in improving cancer detection rates. The level of skill required to achieve mastery for independent practice may be assessed from the accuracy results of prostate biopsy procedures, and trainees with poor rates will require more technical training to improve precision.

Seasonal variations in overactive bladder drug prescription rates in women: a nationwide population-based study.

PURPOSE: Colder seasons can aggravate lower urinary tract symptoms, especially an overactive bladder (OAB). This aspect has been extensively studied in men and rarely in women. We investigated whether colder seasons influence OAB-drug prescription rates (OAB-DPRs) in women. METHODS: Women aged > 18 years were selected from the Korean Health Insurance Review and Assessment Service-National Patient Sample data between 2012 and 2016. OAB-DPR was calculated according to age and seasonal groups. The prescription rates in summer (June, July, and August) and winter (January, February, and December) months were compared. Sub-analysis was performed according to age group. RESULTS: In total, 3,061,343 adult women were included. The overall OAB-DPR was 3.75% (114,940/3,061,343). Overall OAB-DPRs in summer and winter were 1.41% (43,090/3,061,343) and 1.54% (47,038/3,061,343), respectively (p < 0.001). Seasonal variations in OAB-DPRs differed by age group (p < 0.001): OAB-DPRs were significantly lower in winter than in summer months in women aged < 50 years (odds ratio 0.942; 95% confidence interval 0.918-0.967; p < 0.001), but significantly higher in winter than in summer months in women aged ≥ 50 years (odds ratio 1.153; 95% confidence interval 1.135-1.171; p < 0.001). CONCLUSION: In this study, a correlation was noted between OAB-DPR and seasons. OAB-DPRs were higher in the summer in women aged < 50 years and higher in the winter in women aged ≥ 50 years. Our findings suggest that female hormonal status may be involved in the contradictory effect of seasons on OAB symptoms.

Pain relieving effect of music on patients during transrectal ultrasonography: A pilot study.

BACKGROUND: Patient discomfort is often inevitable during transrectal ultrasonography (TRUS), a widely used modality for evaluating benign prostate hyperplasia/lower urinary tract symptoms. Music has been suggested as a method of pain relief during urologic procedures. In this study, we investigated the effect of music on pain relief during TRUS. METHODS: In a pilot study conducted from March to June 2019, pain scores of 316 patients who underwent TRUS with or without music were quantified using the visual analog scale (VAS). One-to-one propensity score matching was performed by matching the subjects between the groups. Patients with hemorrhoids of grade ≥ III were excluded (n = 4). RESULTS: Among the 312 patients included in the study (VAS score = 3.3 ± 2.4), 177 listened to music during the procedure. There were significant differences in age, prostate-specific antigen, prostate volume, International Prostate Symptom Score symptom/life score, and VAS score between the music (+) and music (-) groups. After adjusting for relevant variables, VAS scores were significantly lower in male patients aged ≥65.0 years who underwent music intervention than in those who did not (1.5 ± 1.4 vs. 3.0 ± 1.4, p = 0.002). CONCLUSION: Age was negatively associated with pain during TRUS, and music had a relieving effect on pain in patients aged ≥65.0 years. Our findings may help improve the quality of examinations in urologic outpatient offices.

Seasonal Variation of Drug Prescription Rate for Overactive Bladder in Men Based on National Health Insurance Claims Data, 2012-2016.

PURPOSE: Overactive bladder (OAB) symptoms might be affected by weather, but only a few clinical studies have investigated this issue. We investigated seasonal variations in OAB-drug prescription rate (DPR) in men using nationwide claims data in Korea. METHODS: A total of 2,824,140 men aged over 18 years were included from the Health Insurance Review and Assessment service - National Patient Sample data between 2012 and 2016. Depending on the monthly average temperature, the seasons were divided into 3 groups, namely, hot (June, July, August, and September), intermediate (April, May, October, and November), and cold (January, February, March, and December) seasons. OAB-DPR was estimated using the claims data, and differences in its rate were examined among the 3 seasonal groups. RESULTS: The overall OAB-DPR was 1.97% (55,574 of 2,824,140). The OAB-DPR were 0.38%, 0.63%, 0.92%, 1.74%, 4.18%, 7.55%, and 9.69% in the age groups of under 30, 30s, 40s, 50s, 60s, 70s, and over 80 years, respectively; thus, the prescription rate increased with age (P<0.001), with a steeper increase after 60 years of age. OAB-DPR was 1.02% in the hot season, 1.19% in the intermediate season, and 1.27% in the cold season, with significant differences among the 3 seasonal groups (P<0.001). These seasonal variations persisted in the subgroup analysis in each age decade (P<0.001). CONCLUSION: OAB-DPR varied with seasons and was significantly higher in the cold season than in the hot season, suggesting that cold weather may affect development and aggravation of OAB symptoms in men.

The role of prostatic apex shape in voiding symptoms and urine flow: an exploratory and confirmatory study.

PURPOSE: Lower urinary tract symptoms in men have previously been attributed to obstruction from an enlarged prostate. However, several factors in addition to prostate volume have been identified as impacting urine flow. Prostatic apex shape is one factor that has not been evaluated. This study evaluates the relationship between prostatic apex shape and voiding symptoms and urine flow. METHODS: A retrospective, exploratory data review was conducted for 806 healthy men who underwent routine transrectal ultrasonography at our hospital, and data for 329 patients with uroflowmetric measurements were reviewed for the confirmatory study. Patients were categorized into four groups according to the prostatic apex shape on midsagittal ultrasonography. The association between prostatic apex shape and voiding symptoms was investigated. International Prostate Symptom Score (IPSS) and uroflowmetry were measured, and the associations between IPSS, uroflowmetry, and prostatic apex shape were analyzed. RESULTS: Patients in group 4 (356/806, 44.2%), whose prostatic apex did not overlap the membranous urethra anteriorly or posteriorly, had a significantly lower incidence of moderate and severe lower urinary tract symptoms compared to other groups. There was a significant relationship between prostatic apex shape and total International Prostate Symptom Score. Patients in group 3, whose prostatic apex overlapped posteriorly with the membranous urethra, had lower maximum flow rates on uroflowmetry. There were significant correlations between the maximum flow rate and independent factors including age, intravesicle prostatic protrusion, and prostatic apex shape. CONCLUSIONS: Prostatic apex shape is an independent risk factor for voiding symptom severity and low maximum flow rate.

Precision-aware self-quantizing hardware architectures for the discrete wavelet transform.

This paper presents designs for both bit-parallel (BP) and digit-serial (DS) precision-optimized implementations of the discrete wavelet transform (DWT), with specific consideration given to the impact of depth (the number of levels of DWT) on the overall computational accuracy. These methods thus allow customizing the precision of a multilevel DWT to a given error tolerance requirement and ensuring an energy-minimal implementation, which increases the applicability of DWT-based algorithms such as JPEG 2000 to energy-constrained platforms and environments. Additionally, quantization of DWT coefficients to a specific target step size is performed as an inherent part of the DWT computation, thereby eliminating the need to have a separate downstream quantization step in applications such as JPEG 2000. Experimental measurements of design performance in terms of area, speed, and power for 90-nm complementary metal-oxide-semiconductor implementation are presented. Results indicate that while BP designs exhibit inherent speed advantages, DS designs require significantly fewer hardware resources with increasing precision and DWT level. A four-level DWT with medium precision, for example, while the BP design is four times faster than the digital-serial design, occupies twice the area. In addition to the BP and DS designs, a novel flexible DWT processor is presented, which supports run-time configurable DWT parameters.

Energy-efficient image compression for resource-constrained platforms.

One of the most important goals of current and future sensor networks is energy-efficient communication of images. This paper presents a quantitative comparison between the energy costs associated with 1) direct transmission of uncompressed images and 2) sensor platform-based JPEG compression followed by transmission of the compressed image data. JPEG compression computations are mapped onto various resource-constrained platforms using a design environment that allows computation using the minimum integer and fractional bit-widths needed in view of other approximations inherent in the compression process and choice of image quality parameters. Advanced applications of JPEG, such as region of interest coding and successive/progressive transmission, are also examined. Detailed experimental results examining the tradeoffs in processor resources, processing/transmission time, bandwidth utilization, image quality, and overall energy consumption are presented.